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General NPI Number Information
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NPI Number | 1427672047
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Entity Type | Organization
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Legal Business Name | 5203 CREST RIDGE DRIVE
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 10050 WEST ROAD
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City | HOUSTON
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State | TX
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Zip | 77064
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Country | US
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Telephone | 470-363-0392
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Fax |
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Provider Business Mailing Address
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Address Line | 10419 CUTTING HORSE LN
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City | HOUSTON
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State | TX
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Zip | 77064-7101
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Country | US
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Telephone | 404-992-1941
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MUZBAU ADEEYO
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Credential |
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Telephone | 470-363-0392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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