Provider Demographics
NPI:1144317207
Name:BEST DOMINION HEALTHCARE SERVICES, IN
Entity type:Organization
Organization Name:BEST DOMINION HEALTHCARE SERVICES, IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOLAJI
Authorized Official - Middle Name:KEHINDE
Authorized Official - Last Name:ADEYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-266-0250
Mailing Address - Street 1:11510 W BELLFORT AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-4657
Mailing Address - Country:US
Mailing Address - Phone:713-266-0250
Mailing Address - Fax:713-266-0256
Practice Address - Street 1:11510 W BELLFORT AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-4657
Practice Address - Country:US
Practice Address - Phone:713-266-0250
Practice Address - Fax:713-266-0256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009711251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001012814Medicaid
TX679410Medicare UPIN
TX679410Medicare ID - Type UnspecifiedL&CHHS
TX001012814Medicaid