MEDICARE: SUFFICIENT GROUP HOME LLC.

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	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578137477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUFFICIENT GROUP HOME LLC.

Provider Business Mailing Address
First Line	:	7502 CORPORATE DR APT 37
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-5938
Country	:	US
Telephone Number	:	832-670-3389
Fax Number	:

Provider Business Practice Location Address
First Line	:	7502 CORPORATE DR APT 37
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-5938
Country	:	US
Telephone Number	:	832-670-3389
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. CHIJIOKE CANICE EBERE
Credential	:
Telephone Number	:	183-267-0338

Provider Enumeration Date	:	05/14/2021
Last Update Date	:	05/14/2021

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