Provider Demographics
NPI:1033535810
Name:CYANN CENTER
Entity Type:Organization
Organization Name:CYANN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-454-4313
Mailing Address - Street 1:PO BOX 331355
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77233-1355
Mailing Address - Country:US
Mailing Address - Phone:713-454-4313
Mailing Address - Fax:
Practice Address - Street 1:3800 COUNTY ROAD 94
Practice Address - Street 2:APT 23305
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-2958
Practice Address - Country:US
Practice Address - Phone:713-454-4313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities