Provider Demographics
NPI:1720160286
Name:CHRISBORN INC
Entity type:Organization
Organization Name:CHRISBORN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DUBANIMI
Authorized Official - Middle Name:EEBA
Authorized Official - Last Name:NWADIEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-725-4730
Mailing Address - Street 1:13698 TONNOCHY CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083
Mailing Address - Country:US
Mailing Address - Phone:713-725-4730
Mailing Address - Fax:866-703-8463
Practice Address - Street 1:13698 TONNOCHY CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083
Practice Address - Country:US
Practice Address - Phone:713-725-4730
Practice Address - Fax:866-703-8463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001007815320900000X
320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001007815OtherHCS CONTRACT NUMBER
TX001010383OtherTEXAS HOME LIVING