Provider Demographics
NPI:1902009160
Name:NICOLE WHITE
Entity Type:Organization
Organization Name:NICOLE WHITE
Other - Org Name:ACCOMMODATIVE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-516-2029
Mailing Address - Street 1:PO BOX 90166
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77290-0166
Mailing Address - Country:US
Mailing Address - Phone:713-516-2029
Mailing Address - Fax:
Practice Address - Street 1:1235 NORTH LOOP W STE 1015
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-4708
Practice Address - Country:US
Practice Address - Phone:713-863-7000
Practice Address - Fax:713-863-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001008070305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001008070OtherCONTRACT NUMBER