Organization
PROVIDIAN TOTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL IHEKORONYE RRT (MANAGER)
(832) 512-3234
Entity
Organization
Contact information
Practice address
618 TRAVIS ST, BAYTOWN, TX 77520-7568
(832) 512-3234
(832) 615-0813
Mailing address
718 MISTYCREEK DR, RICHMOND, TX 77406-1263
(832) 615-0813
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/30/2010
Last updated
09/30/2010
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