Provider Demographics
NPI:1598138968
Name:CONSONUS
Entity Type:Organization
Organization Name:CONSONUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTA
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:O
Authorized Official - Last Name:AGOGO
Authorized Official - Suffix:
Authorized Official - Credentials:THERAPIST
Authorized Official - Phone:682-234-5690
Mailing Address - Street 1:5102 HADDONSTONE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1890
Mailing Address - Country:US
Mailing Address - Phone:682-234-5689
Mailing Address - Fax:
Practice Address - Street 1:5102 HADDONSTONE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1890
Practice Address - Country:US
Practice Address - Phone:682-234-5689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-07
Last Update Date:2015-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224Z00000X314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility