Provider Demographics
NPI:1457385411
Name:CRUSADE INTEGRATED HEALTH SERVICES,LLC
Entity Type:Organization
Organization Name:CRUSADE INTEGRATED HEALTH SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CONSUELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:YANCY-COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-778-9468
Mailing Address - Street 1:10101 FONDREN RD STE 327
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-5124
Mailing Address - Country:US
Mailing Address - Phone:713-778-9468
Mailing Address - Fax:713-778-9469
Practice Address - Street 1:10101 FONDREN RD STE 327
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-5124
Practice Address - Country:US
Practice Address - Phone:713-778-9468
Practice Address - Fax:713-778-9469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155720902Medicaid
TX155720901Medicaid
TX4692090001Medicare NSC