Provider Demographics
NPI:1548513260
Name:HEALTHGENIX LLC
Entity type:Organization
Organization Name:HEALTHGENIX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUARAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-774-7747
Mailing Address - Street 1:19607 NORFOLK RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407
Mailing Address - Country:US
Mailing Address - Phone:832-774-7747
Mailing Address - Fax:832-566-9786
Practice Address - Street 1:19607 NORFOLK RIDGE WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-7123
Practice Address - Country:US
Practice Address - Phone:832-774-7747
Practice Address - Fax:832-565-9786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2013-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX253Z00000X, 251C00000X, 261QM0801X, 310400000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility