Provider Demographics
NPI:1144405812
Name:AMANUEL D ATSBAHA
Entity Type:Organization
Organization Name:AMANUEL D ATSBAHA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AMANUEL
Authorized Official - Middle Name:DEBESAY
Authorized Official - Last Name:ATSBAHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-704-8495
Mailing Address - Street 1:7400BELLERIVE APT.1303
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036
Mailing Address - Country:US
Mailing Address - Phone:281-704-8495
Mailing Address - Fax:713-974-6653
Practice Address - Street 1:7400 BELLERIVE DR APT 1303
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3048
Practice Address - Country:US
Practice Address - Phone:281-704-8495
Practice Address - Fax:713-974-6653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities