Provider Demographics
NPI:1386848539
Name:OKEADU, CHUCK C SR (PT)
Entity Type:Individual
Prefix:MR
First Name:CHUCK
Middle Name:C
Last Name:OKEADU
Suffix:SR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SPECIAL HOME CARE LIVING CENTER
Mailing Address - Street 2:9898 BISSONNET SUITE 585
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036
Mailing Address - Country:US
Mailing Address - Phone:713-771-3133
Mailing Address - Fax:713-771-3113
Practice Address - Street 1:SPECIAL HOME CARE LIVING CENTER
Practice Address - Street 2:9898 BISSONNET SUITE 585
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036
Practice Address - Country:US
Practice Address - Phone:713-771-3133
Practice Address - Fax:713-771-3113
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X, 251S00000X
TX82A171W00000X, 261QC1500X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111894502Medicaid
TX111894503Medicaid
TX82AMedicaid
TX111894501Medicaid
TX00663KMedicare ID - Type UnspecifiedMULTI-SPECIAL CLINIC
TX82AMedicaid