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General NPI Number Information
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NPI Number | 1235432030
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Entity Type | Organization
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Legal Business Name | PAVILION OF REDEMPTION HEALTHCARE SYSTEMS, INC.
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Dates
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Enumeration Date | 12/16/2010
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Last Update Date | 05/31/2011
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Provider Practice Location Address
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Address Line | 10925 BEECHNUT ST B204-60
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City | HOUSTON
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State | TX
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Zip | 77072-4351
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Country | US
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Telephone | 281-983-3500
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Fax | 281-983-3502
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Provider Business Mailing Address
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Address Line | 10925 BEECHNUT ST B204-60
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City | HOUSTON
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State | TX
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Zip | 77072-4351
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Country | US
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Telephone | 281-983-3500
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Fax | 281-983-3502
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Authorized Official
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Title or Position | ADMINISTRATOR & CEO
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Name | PETER O AWOFODU
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Credential | R.N.
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Telephone | 281-983-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 014000
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License Number State | TX
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