Provider Demographics
NPI:1568827343
Name:STGL PEDIATRIC DIVINE TOUCH INC
Entity Type:Organization
Organization Name:STGL PEDIATRIC DIVINE TOUCH INC
Other - Org Name:STGL PEDIATRIC DIVINE TOUCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NWAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-378-3174
Mailing Address - Street 1:618 EASY JET DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-6358
Mailing Address - Country:US
Mailing Address - Phone:832-378-3174
Mailing Address - Fax:281-760-1108
Practice Address - Street 1:618 EASY JET DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-6358
Practice Address - Country:US
Practice Address - Phone:832-378-3174
Practice Address - Fax:281-760-1108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX810794120OtherEIN