Provider Demographics
NPI:1326328592
Name:QAVENI HOLDING LLC
Entity Type:Organization
Organization Name:QAVENI HOLDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:OKPAKO
Authorized Official - Last Name:IDJAGBORO
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:832-366-5980
Mailing Address - Street 1:8449 WEST BELLFORT ROAD
Mailing Address - Street 2:SUITE 285
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071
Mailing Address - Country:US
Mailing Address - Phone:832-366-5980
Mailing Address - Fax:713-900-6007
Practice Address - Street 1:8449 W BELLFORT ST
Practice Address - Street 2:SUITE 285
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-2245
Practice Address - Country:US
Practice Address - Phone:832-366-5980
Practice Address - Fax:713-900-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
TXPA03357363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty