Provider Demographics
NPI:1588194484
Name:AFFECTIONATE HEART INC
Entity Type:Organization
Organization Name:AFFECTIONATE HEART INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAZAK
Authorized Official - Middle Name:
Authorized Official - Last Name:OKUNEYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-762-2339
Mailing Address - Street 1:11104 W AIRPORT BLVD STE 141
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3040
Mailing Address - Country:US
Mailing Address - Phone:1281-762-2339
Mailing Address - Fax:
Practice Address - Street 1:11104 W AIRPORT BLVD STE 141
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3040
Practice Address - Country:US
Practice Address - Phone:1281-762-2339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty