Provider Demographics
NPI:1639415748
Name:ABIDE CARE GROUP INC
Entity Type:Organization
Organization Name:ABIDE CARE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MODUPE
Authorized Official - Middle Name:ADETUTU
Authorized Official - Last Name:OKUNSANYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-287-7717
Mailing Address - Street 1:15770 BELLAIRE BLVD APT 2612
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-3012
Mailing Address - Country:US
Mailing Address - Phone:832-287-7717
Mailing Address - Fax:
Practice Address - Street 1:15770 BELLAIRE BLVD APT 2612
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-3012
Practice Address - Country:US
Practice Address - Phone:832-287-7717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000000Medicaid