Provider Demographics
NPI:1598318917
Name:ST DAVIS CORPORATION
Entity Type:Organization
Organization Name:ST DAVIS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NOMSO
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:EGWIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-382-3737
Mailing Address - Street 1:14243 HAWKESBURY CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-9752
Mailing Address - Country:US
Mailing Address - Phone:424-382-3737
Mailing Address - Fax:
Practice Address - Street 1:14243 HAWKESBURY CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-9752
Practice Address - Country:US
Practice Address - Phone:424-382-3737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health