Provider Demographics
NPI:1255641940
Name:CTB ULTIMATE HEALTHCARE FACILITY
Entity type:Organization
Organization Name:CTB ULTIMATE HEALTHCARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:WHITE-BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-433-9059
Mailing Address - Street 1:23219 WOLFS CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-8166
Mailing Address - Country:US
Mailing Address - Phone:281-433-9059
Mailing Address - Fax:281-651-6551
Practice Address - Street 1:301 WELLS FARGO DR
Practice Address - Street 2:SUITE C6
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-4060
Practice Address - Country:US
Practice Address - Phone:281-433-9059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization