1235432030 NPI number — PAVILION OF REDEMPTION HEALTHCARE SYSTEMS, INC.

Table of content: (NPI 1235432030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235432030 NPI number — PAVILION OF REDEMPTION HEALTHCARE SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAVILION OF REDEMPTION HEALTHCARE SYSTEMS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235432030
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10925 BEECHNUT ST
Provider Second Line Business Mailing Address:
B204-60
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77072-4351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-983-3500
Provider Business Mailing Address Fax Number:
281-983-3502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10925 BEECHNUT ST
Provider Second Line Business Practice Location Address:
B204-60
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77072-4351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-983-3500
Provider Business Practice Location Address Fax Number:
281-983-3502
Provider Enumeration Date:
12/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
AWOFODU
Authorized Official First Name:
PETER
Authorized Official Middle Name:
O
Authorized Official Title or Position:
ADMINISTRATOR & CEO
Authorized Official Telephone Number:
281-983-3500

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  014000 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NONE . This is a "NONE AT THIS TIME" identifier . This identifiers is of the category "OTHER".




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