Provider Demographics
NPI:1164549085
Name:IDEAL CARE PROVIDERS,INC.
Entity Type:Organization
Organization Name:IDEAL CARE PROVIDERS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUSTINA
Authorized Official - Middle Name:U
Authorized Official - Last Name:ONUH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-499-9512
Mailing Address - Street 1:1906 HICKORY GLEN DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3092
Mailing Address - Country:US
Mailing Address - Phone:281-499-9512
Mailing Address - Fax:281-499-9583
Practice Address - Street 1:1906 HICKORY GLEN DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-3092
Practice Address - Country:US
Practice Address - Phone:281-499-9512
Practice Address - Fax:281-499-9583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011054314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679794Medicare Oscar/Certification