Provider Demographics
NPI:1013738764
Name:UDABOR, HENDRIX (MANAGER)
Entity type:Individual
Prefix:
First Name:HENDRIX
Middle Name:
Last Name:UDABOR
Suffix:
Gender:M
Credentials:MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 CRAWFORD DR
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-1617
Mailing Address - Country:US
Mailing Address - Phone:214-355-8628
Mailing Address - Fax:
Practice Address - Street 1:4701 CRAWFORD DR
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-1617
Practice Address - Country:US
Practice Address - Phone:214-355-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0232333747P1801X
TX253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty