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General NPI Number Information
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NPI Number | 1235404260
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Entity Type | Organization
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Legal Business Name | PRICO HEALTH LLC
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Dates
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Enumeration Date | 03/08/2012
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Last Update Date | 01/16/2018
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Provider Practice Location Address
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Address Line | 787 E FM 1187 STE C
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City | CROWLEY
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State | TX
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Zip | 76036-4357
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Country | US
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Telephone | 817-297-8446
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Fax | 866-693-2857
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Provider Business Mailing Address
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Address Line | 787 E FM 1187 STE C
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City | CROWLEY
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State | TX
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Zip | 76036-4357
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Country | US
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Telephone | 817-297-8446
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Fax | 866-693-2857
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Authorized Official
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Title or Position | CEO
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Name | MR. JEHAN C PROVIDENZA
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Credential | MBA
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Telephone | 817-297-8446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State | TX
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