Provider Demographics
NPI:1184079329
Name:AZA
Entity type:Organization
Organization Name:AZA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWONER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-230-6794
Mailing Address - Street 1:8422 ASH GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-6522
Mailing Address - Country:US
Mailing Address - Phone:832-230-6794
Mailing Address - Fax:
Practice Address - Street 1:8422 ASH GARDEN CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-6522
Practice Address - Country:US
Practice Address - Phone:832-230-6794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AZA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health