Provider Demographics
NPI:1144697681
Name:COORDINATING CARE CENTER
Entity type:Organization
Organization Name:COORDINATING CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLENDADALE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-446-0061
Mailing Address - Street 1:9816 MEMORIAL BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4205
Mailing Address - Country:US
Mailing Address - Phone:281-446-0061
Mailing Address - Fax:
Practice Address - Street 1:9816 MEMORIAL BLVD STE 105
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4205
Practice Address - Country:US
Practice Address - Phone:281-446-0061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEERBROOK PHARMACY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146076Medicaid
TX6853310001Medicare NSC