Provider Demographics
NPI:1336326735
Name:MEMORIALE HEALTHCARE AND SUPPORT SERVICES INC
Entity Type:Organization
Organization Name:MEMORIALE HEALTHCARE AND SUPPORT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NKODO
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:AKPANINYANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-373-7616
Mailing Address - Street 1:12818 CENTURY DR., # 105 - 106
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4224
Mailing Address - Country:US
Mailing Address - Phone:713-373-7616
Mailing Address - Fax:713-234-7526
Practice Address - Street 1:12818 CENTURY DR., # 105 - 106
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4224
Practice Address - Country:US
Practice Address - Phone:713-373-7616
Practice Address - Fax:713-234-7526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health