Provider Demographics
NPI:1912002338
Name:CHARLTON C ANYAGAFU
Entity Type:Organization
Organization Name:CHARLTON C ANYAGAFU
Other - Org Name:CARDINAL CASE MANAGEMENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLTON
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANYAGAFU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-484-8890
Mailing Address - Street 1:10039 BISSONNET ST
Mailing Address - Street 2:SUITE 227
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7854
Mailing Address - Country:US
Mailing Address - Phone:713-484-8890
Mailing Address - Fax:713-484-8824
Practice Address - Street 1:10039 BISSONNET ST
Practice Address - Street 2:SUITE 227
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7854
Practice Address - Country:US
Practice Address - Phone:713-484-8890
Practice Address - Fax:713-484-8824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000000251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX251B00000XMedicaid