Provider Demographics
NPI:1033568464
Name:ESKRIDGE VALLEY
Entity Type:Organization
Organization Name:ESKRIDGE VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WINBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-498-9102
Mailing Address - Street 1:2929 ALLEN PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-7100
Mailing Address - Country:US
Mailing Address - Phone:314-498-9102
Mailing Address - Fax:
Practice Address - Street 1:2929 ALLEN PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-7100
Practice Address - Country:US
Practice Address - Phone:314-498-9102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid