Provider Demographics
NPI:1891558672
Name:MEDEKAN ONLINE SERVICES
Entity type:Organization
Organization Name:MEDEKAN ONLINE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:UDOKAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-582-8336
Mailing Address - Street 1:1853 PEARLAND PKWY STE 123-1145
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5296
Mailing Address - Country:US
Mailing Address - Phone:346-582-8336
Mailing Address - Fax:713-583-7839
Practice Address - Street 1:2743 SMITH RANCH RD STE 902A
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5217
Practice Address - Country:US
Practice Address - Phone:346-582-8336
Practice Address - Fax:713-583-7836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities