Provider Demographics
NPI:1841000734
Name:BEDROCK HEALTHCARE SERVICES
Entity type:Organization
Organization Name:BEDROCK HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADEBOLA
Authorized Official - Middle Name:MAYOKUN
Authorized Official - Last Name:OSUNDAHINSI
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:832-860-3449
Mailing Address - Street 1:17211 ASTRACHAN RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2701
Mailing Address - Country:US
Mailing Address - Phone:281-745-1589
Mailing Address - Fax:
Practice Address - Street 1:17211 ASTRACHAN RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2701
Practice Address - Country:US
Practice Address - Phone:281-745-1589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty