Provider Demographics
NPI:1891142857
Name:MOZARA AGENCY OF AMERICA LLC
Entity Type:Organization
Organization Name:MOZARA AGENCY OF AMERICA LLC
Other - Org Name:ROYAL PREMIUM GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRINCE
Authorized Official - Middle Name:
Authorized Official - Last Name:EGBENYOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-306-6336
Mailing Address - Street 1:21747 SIERRA LONG DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407
Mailing Address - Country:US
Mailing Address - Phone:832-306-6336
Mailing Address - Fax:
Practice Address - Street 1:21747 SIERRA LONG DRIVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407
Practice Address - Country:US
Practice Address - Phone:832-306-6336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health