Provider Demographics
NPI:1790790491
Name:CITY CROWN HOME HEALTH AGENCY INC.
Entity Type:Organization
Organization Name:CITY CROWN HOME HEALTH AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALT. ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EPHRAIM
Authorized Official - Middle Name:E
Authorized Official - Last Name:OKAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:BS; BBA; MBA
Authorized Official - Phone:281-486-2020
Mailing Address - Street 1:1560 W BAY AREA BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-2678
Mailing Address - Country:US
Mailing Address - Phone:281-486-2020
Mailing Address - Fax:281-486-2096
Practice Address - Street 1:1560 W BAY AREA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-2678
Practice Address - Country:US
Practice Address - Phone:281-486-2020
Practice Address - Fax:281-486-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190878201Medicaid
TX457908Medicare Oscar/Certification