Provider Demographics
NPI:1689628877
Name:EVENING STAR HEALTHCARE, INC.
Entity Type:Organization
Organization Name:EVENING STAR HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MBIDOAKA
Authorized Official - Suffix:
Authorized Official - Credentials:BSC, LVN
Authorized Official - Phone:281-344-1411
Mailing Address - Street 1:6111 EVENING SUN CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-9873
Mailing Address - Country:US
Mailing Address - Phone:281-344-1411
Mailing Address - Fax:281-344-1611
Practice Address - Street 1:6111 EVENING SUN CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-9873
Practice Address - Country:US
Practice Address - Phone:281-344-1411
Practice Address - Fax:281-344-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009549251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009549OtherHCSSA LICENSE
TX009549OtherHCSSA LICENSE