Provider Demographics
NPI:1982221701
Name:AA1 HOME & COMMUNITY BASE SERVICES
Entity Type:Organization
Organization Name:AA1 HOME & COMMUNITY BASE SERVICES
Other - Org Name:AA1- HOME & COMMUNITY BASE SERVICES LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:ENORUWA
Authorized Official - Last Name:OMIGIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-659-6895
Mailing Address - Street 1:26630 BELLWOOD PINES DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-0556
Mailing Address - Country:US
Mailing Address - Phone:832-754-0216
Mailing Address - Fax:
Practice Address - Street 1:26630 BELLWOOD PINES DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-0556
Practice Address - Country:US
Practice Address - Phone:832-659-6895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-27
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children