1689614448 NPI number — MADONNA HEALTH CARE SERVICES, INC.

Table of content: (NPI 1689614448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689614448 NPI number — MADONNA HEALTH CARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MADONNA HEALTH CARE SERVICES, 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:
1689614448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8700 COMMERCE PARK DR
Provider Second Line Business Mailing Address:
SUITE # 216
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77036-7497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-232-8118
Provider Business Mailing Address Fax Number:
832-595-1555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 SOUTH 9TH STREET
Provider Second Line Business Practice Location Address:
SUITE # 116
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77469-3348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-232-8118
Provider Business Practice Location Address Fax Number:
832-595-1555
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARISE
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
281-232-8118

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  010446 , 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)





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