Organization
CONSONUS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWIN O AGOGO THERAPIST (OTA)
(682) 234-5690
Entity
Organization
Contact information
Practice address
5102 HADDONSTONE DR, ARLINGTON, TX 76017-1890
(682) 234-5689
Mailing address
5102 HADDONSTONE DR, ARLINGTON, TX 76017-1890
(682) 234-5689
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
224Z00000X
TX
Other
Enumeration date
11/07/2015
Last updated
11/07/2015
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