Provider Demographics
NPI:1346890860
Name:AQUARIUM HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:AQUARIUM HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BONISWA
Authorized Official - Middle Name:PORTIA
Authorized Official - Last Name:MADUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-805-0933
Mailing Address - Street 1:8000 COOK RD APT 1109
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-3939
Mailing Address - Country:US
Mailing Address - Phone:832-805-0933
Mailing Address - Fax:
Practice Address - Street 1:8000 COOK RD APT 1109
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-3939
Practice Address - Country:US
Practice Address - Phone:832-805-0933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities