Provider Demographics
NPI:1427883289
Name:MAO'S PROVIDER SERVICES
Entity type:Organization
Organization Name:MAO'S PROVIDER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOSUNMOLA
Authorized Official - Middle Name:TEMITAYO
Authorized Official - Last Name:ODUNSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-851-7549
Mailing Address - Street 1:13107 CRESSIDA GLEN LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-0113
Mailing Address - Country:US
Mailing Address - Phone:918-851-7549
Mailing Address - Fax:
Practice Address - Street 1:13107 CRESSIDA GLEN LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-0113
Practice Address - Country:US
Practice Address - Phone:918-851-7549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care