1700170081 NPI number — INTEGRITY HEALTHCARE SUPPORTS

Table of content: (NPI 1700170081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700170081 NPI number — INTEGRITY HEALTHCARE SUPPORTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRITY HEALTHCARE SUPPORTS
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:
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:
1700170081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6300 HILLCROFT ST
Provider Second Line Business Mailing Address:
200
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77081-3006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-563-5889
Provider Business Mailing Address Fax Number:
713-278-9711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6300 HILLCROFT ST
Provider Second Line Business Practice Location Address:
200
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77081-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-563-5889
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ETUKUDO
Authorized Official First Name:
ASSUMPTA
Authorized Official Middle Name:
SUNDAY
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
832-536-5889

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251B00000X , with the licence number: LSW 23892 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , with the licence number: LSW11758 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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