Provider Demographics
NPI:1801610241
Name:ADEWOLE BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:ADEWOLE BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERONE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-529-7822
Mailing Address - Street 1:13223 ELDRIDGE CHASE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-1757
Mailing Address - Country:US
Mailing Address - Phone:346-529-7822
Mailing Address - Fax:
Practice Address - Street 1:13223 ELDRIDGE CHASE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-1757
Practice Address - Country:US
Practice Address - Phone:346-529-7822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center