Provider Demographics
NPI:1194942128
Name:CRISEVEN HEALTH MGT CORP
Entity type:Organization
Organization Name:CRISEVEN HEALTH MGT CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOKWUAH-NWORAH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-785-8858
Mailing Address - Street 1:6105 BEVERLY HILL ST
Mailing Address - Street 2:STE 103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057
Mailing Address - Country:US
Mailing Address - Phone:713-785-8858
Mailing Address - Fax:713-785-8865
Practice Address - Street 1:6105 BEVERLY HILL ST
Practice Address - Street 2:STE 103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057
Practice Address - Country:US
Practice Address - Phone:713-785-8858
Practice Address - Fax:713-785-8865
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRISEVEN HEALTH MGT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-19
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010310251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679653Medicare Oscar/Certification