Provider Demographics
NPI:1609013390
Name:UNITED CEREBRAL PALSY OF GREATER HOUSTON, INC.
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY OF GREATER HOUSTON, INC.
Other - Org Name:OVER 3 THERAPY PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMISTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-838-9050
Mailing Address - Street 1:4500 BISSONNET ST
Mailing Address - Street 2:# 340
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4500 BISSONNET ST
Practice Address - Street 2:# 340
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3009
Practice Address - Country:US
Practice Address - Phone:713-838-9050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy