Provider Demographics
NPI:1558594382
Name:OBOSA HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:OBOSA HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:OBASOGIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-690-1941
Mailing Address - Street 1:16703 LAZY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77053-4663
Mailing Address - Country:US
Mailing Address - Phone:713-429-1873
Mailing Address - Fax:
Practice Address - Street 1:16703 LAZY RIDGE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77053-4663
Practice Address - Country:US
Practice Address - Phone:713-429-1873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities