Provider Demographics
NPI:1447608690
Name:OSA HERITAGE HOMES, INC.
Entity Type:Organization
Organization Name:OSA HERITAGE HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IZEHIESE
Authorized Official - Middle Name:I
Authorized Official - Last Name:OBANOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-392-1786
Mailing Address - Street 1:2419 FAIRBREEZE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5103
Mailing Address - Country:US
Mailing Address - Phone:832-392-1786
Mailing Address - Fax:
Practice Address - Street 1:4218 BRANNON BRANCH CT
Practice Address - Street 2:
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-1543
Practice Address - Country:US
Practice Address - Phone:832-392-1786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144751253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care