Provider Demographics
NPI:1437770088
Name:THE BISMACK
Entity Type:Organization
Organization Name:THE BISMACK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:UCHE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANIMADU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-940-9184
Mailing Address - Street 1:14835 WALBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-1019
Mailing Address - Country:US
Mailing Address - Phone:832-348-7062
Mailing Address - Fax:
Practice Address - Street 1:8408 HIGHWAY 6 S
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-5707
Practice Address - Country:US
Practice Address - Phone:281-940-9184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health