Providian Total Health LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

PROVIDIAN TOTAL HEALTH LLC

Practice address

618 Travis St
Baytown, TX 77520-7568

Phone

(832) 512-3234

Fax

(832) 615-0813

NPI assigned

Sep 30, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Ihekoronye, RRT

Title

Manager

Phone

(832) 512-3234

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285804800000",
    "number": "1740599240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "718 MISTYCREEK DR",
            "city": "RICHMOND",
            "state": "TX",
            "postal_code": "774061263",
            "fax_number": "832-615-0813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 TRAVIS ST",
            "city": "BAYTOWN",
            "state": "TX",
            "postal_code": "775207568",
            "telephone_number": "832-512-3234",
            "fax_number": "832-615-0813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDIAN TOTAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-30",
        "last_updated": "2010-09-30",
        "status": "A",
        "authorized_official_last_name": "IHEKORONYE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "832-512-3234",
        "authorized_official_credential": "RRT"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Donna L Prudhomme, RPH
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• Sharlene Pryer
• Deldrya Pugh

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Baytown, TX
• Providers in Baytown, TX by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.