Provider Demographics
NPI:1972541084
Name:C & C ULTRA HEALTHCARE PROVIDERS INC
Entity type:Organization
Organization Name:C & C ULTRA HEALTHCARE PROVIDERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUNZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-822-1381
Mailing Address - Street 1:6001 SAVOY DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3395
Mailing Address - Country:US
Mailing Address - Phone:832-804-9649
Mailing Address - Fax:832-649-4988
Practice Address - Street 1:7457 HARWIN DR
Practice Address - Street 2:SUITE 226
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3395
Practice Address - Country:US
Practice Address - Phone:832-804-9649
Practice Address - Fax:832-649-4988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008783251E00000X
TX018080251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1807307-01Medicaid
TX1807307-01Medicaid