Provider Demographics
NPI:1598902363
Name:ST. MICHAEL'S HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:ST. MICHAEL'S HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:SHEKU
Authorized Official - Last Name:MOMOH
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BSN
Authorized Official - Phone:315-601-3152
Mailing Address - Street 1:7324 SKILLMAN ST APT 1502
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4978
Mailing Address - Country:US
Mailing Address - Phone:214-485-1414
Mailing Address - Fax:
Practice Address - Street 1:7324 SKILLMAN ST APT 1502
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4978
Practice Address - Country:US
Practice Address - Phone:315-601-3152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX759787163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty