Provider Demographics
NPI:1023035110
Name:PHAN HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:PHAN HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ONWUMERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-564-3473
Mailing Address - Street 1:14601 BELLAIRE BLVD STE 45
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-2544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:281-564-3475
Practice Address - Street 1:14601 BELLAIRE BLVD STE 45
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-2544
Practice Address - Country:US
Practice Address - Phone:281-564-3473
Practice Address - Fax:281-564-3475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX086Q320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities