=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750913620
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRYSTAL'S TOUCH HCS AND TXHML INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2020
-----------------------------------------------------
Last Update Date | 12/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7710 CULLEN BLVD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77051-1906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-705-2639
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7710 CULLEN BLVD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77051-1906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | CHINENYE C IGUH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-705-2639
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------