Healthcare Provider Details

I. General information

NPI: 1255594149
Provider Name (Legal Business Name): MR. JUSTICE JOLLY AMAECHI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20322 MATHIS LANDING DR
CYPRESS TX
77433-6178
US

IV. Provider business mailing address

20322 MATHIS LANDING DR
CYPRESS TX
77433-6178
US

V. Phone/Fax

Practice location:
  • Phone: 281-213-3315
  • Fax: 281-213-3315
Mailing address:
  • Phone: 281-213-3315
  • Fax: 281-213-3315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: