Provider Demographics
NPI:1184077042
Name:TGI BROOKSTREET INC
Entity type:Organization
Organization Name:TGI BROOKSTREET INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLUMIDE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEBOWALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-491-7578
Mailing Address - Street 1:114 E ALAMO ST
Mailing Address - Street 2:SUITE 33
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-3891
Mailing Address - Country:US
Mailing Address - Phone:832-491-7578
Mailing Address - Fax:
Practice Address - Street 1:114 E ALAMO ST
Practice Address - Street 2:SUITE 33
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-3891
Practice Address - Country:US
Practice Address - Phone:832-491-7578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1000Medicaid