MEDICARE: CITY CROWN PHP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310500000X	Mental Illness Intermediate Care Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689962508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY CROWN PHP INC

Provider Business Mailing Address
First Line	:	2626 RAVEN FALLS LN
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-6072
Country	:	US
Telephone Number	:	832-326-9028
Fax Number	:	281-992-2187

Provider Business Practice Location Address
First Line	:	2626 RAVEN FALLS LN
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-6072
Country	:	US
Telephone Number	:	832-326-9028
Fax Number	:	281-992-2187

Authorized Official
Title or Position	:	CEO
Name	:	MS. VERONICA UZOAMAKA OKAFOR
Credential	:
Telephone Number	:	832-326-9028

Provider Enumeration Date	:	07/12/2011
Last Update Date	:	07/12/2011

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Directions to “CITY CROWN PHP INC ” Practice Location

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