Provider Demographics
NPI:1811207939
Name:PRIMEAGE HEALTH SEVICES , INC
Entity Type:Organization
Organization Name:PRIMEAGE HEALTH SEVICES , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLALEKAN
Authorized Official - Middle Name:ADEMOLA
Authorized Official - Last Name:AGBOLUAJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-385-9800
Mailing Address - Street 1:6250 WESTPARK DR STE 207
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-7322
Mailing Address - Country:US
Mailing Address - Phone:281-385-9800
Mailing Address - Fax:
Practice Address - Street 1:6250 WESTPARK DR STE 207
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7322
Practice Address - Country:US
Practice Address - Phone:281-385-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012279261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX012279OtherSTATE LICENSE