Provider Demographics
NPI:1548213432
Name:COLONIAL HEALTHCARE INC
Entity Type:Organization
Organization Name:COLONIAL HEALTHCARE INC
Other - Org Name:COLONIAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADM / DON
Authorized Official - Prefix:MS
Authorized Official - First Name:ADEYINKA
Authorized Official - Middle Name:OLUBANKE
Authorized Official - Last Name:OKUNUBI
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:713-988-3100
Mailing Address - Street 1:11970 WILCREST DR
Mailing Address - Street 2:103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77031-1923
Mailing Address - Country:US
Mailing Address - Phone:281-988-6500
Mailing Address - Fax:281-988-6502
Practice Address - Street 1:11970 WILCREST DR
Practice Address - Street 2:103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77031-1923
Practice Address - Country:US
Practice Address - Phone:281-988-6500
Practice Address - Fax:281-988-6500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX614340251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX453130Medicare Oscar/Certification