Provider Demographics
NPI:1205651155
Name:GLADE CRESCENT
Entity type:Organization
Organization Name:GLADE CRESCENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABOLORE
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNSOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-554-4897
Mailing Address - Street 1:2823 LEMONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7991
Mailing Address - Country:US
Mailing Address - Phone:615-554-4897
Mailing Address - Fax:
Practice Address - Street 1:2823 LEMONWOOD LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7991
Practice Address - Country:US
Practice Address - Phone:615-554-4897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)