MEDICARE: BLASE ORIEUKWU

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1558546317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLASE ORIEUKWU

Provider Business Mailing Address
First Line	:	4715 CALLERY CREEK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77053-3119
Country	:	US
Telephone Number	:	281-323-5776
Fax Number	:	281-265-7944

Provider Business Practice Location Address
First Line	:	4715 CALLERY CREEK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77053-3119
Country	:	US
Telephone Number	:	281-323-5776
Fax Number	:	281-265-7444

Authorized Official
Title or Position	:	CEO
Name	:	BLASE ORIEUKWU
Credential	:
Telephone Number	:	281-323-5776

Provider Enumeration Date	:	12/29/2007
Last Update Date	:	01/02/2008

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