MEDICARE: VICTORIA CHINURU NDIMELE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1467245027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA CHINURU NDIMELE

Provider Business Mailing Address
First Line	:	7631 FALLEN LEAF
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-3397
Country	:	US
Telephone Number	:	713-679-3746
Fax Number	:

Provider Business Practice Location Address
First Line	:	7631 FALLEN LEAF
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-3397
Country	:	US
Telephone Number	:	713-679-3746
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2025
Last Update Date	:	05/27/2025

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