Provider Demographics
NPI:1427672047
Name:5203 CREST RIDGE DRIVE
Entity type:Organization
Organization Name:5203 CREST RIDGE DRIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUZBAU
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEEYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-363-0392
Mailing Address - Street 1:10419 CUTTING HORSE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-7101
Mailing Address - Country:US
Mailing Address - Phone:404-992-1941
Mailing Address - Fax:
Practice Address - Street 1:10050 WEST ROAD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064
Practice Address - Country:US
Practice Address - Phone:470-363-0392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care