=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801634001
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CIB-LLOYDS HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2024
-----------------------------------------------------
Last Update Date | 07/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9050 COOK RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77099-1463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-558-1212
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2507 PARKHAVEN DR
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77478-6075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-558-1212
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | AUSTIN OKAFOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 682-558-1212
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------