Provider Demographics
NPI:1689962508
Name:CITY CROWN PHP INC
Entity Type:Organization
Organization Name:CITY CROWN PHP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:UZOAMAKA
Authorized Official - Last Name:OKAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-326-9028
Mailing Address - Street 1:2626 RAVEN FALLS LN
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-6072
Mailing Address - Country:US
Mailing Address - Phone:832-326-9028
Mailing Address - Fax:281-992-2187
Practice Address - Street 1:2626 RAVEN FALLS LN
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-6072
Practice Address - Country:US
Practice Address - Phone:832-326-9028
Practice Address - Fax:281-992-2187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190878201Medicaid
457908Medicare Oscar/Certification