Provider Demographics
NPI:1023384138
Name:TEEN HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:TEEN HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHEYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:409-761-3517
Mailing Address - Street 1:PO BOX 925
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77553-0925
Mailing Address - Country:US
Mailing Address - Phone:409-766-5750
Mailing Address - Fax:409-750-9395
Practice Address - Street 1:1514 AVENUE N 1/2
Practice Address - Street 2:ROOM#172
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-8135
Practice Address - Country:US
Practice Address - Phone:409-761-3516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7176393140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric