Provider Demographics
NPI:1164854733
Name:CHREIDI INC
Entity Type:Organization
Organization Name:CHREIDI INC
Other - Org Name:ADJUVANT AMBULANCE TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WISAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:CHREIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:281-704-1077
Mailing Address - Street 1:3006 SKYPARK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-3533
Mailing Address - Country:US
Mailing Address - Phone:281-704-1077
Mailing Address - Fax:713-456-2252
Practice Address - Street 1:6776 SOUTHWEST FWY STE 532
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074
Practice Address - Country:US
Practice Address - Phone:979-633-8437
Practice Address - Fax:713-456-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX361327501Medicaid
TX1000919OtherTDHS