Provider Demographics
NPI:1588423263
Name:A1 NOSTALGIC CARE INC
Entity type:Organization
Organization Name:A1 NOSTALGIC CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LILIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:OBAYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-418-8269
Mailing Address - Street 1:10426 LYRA GLEN LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-3271
Mailing Address - Country:US
Mailing Address - Phone:832-418-8269
Mailing Address - Fax:
Practice Address - Street 1:10426 LYRA GLEN LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-3271
Practice Address - Country:US
Practice Address - Phone:832-418-8269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty
No376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty