Healthcare Provider Details

I. General information

NPI: 1750528667
Provider Name (Legal Business Name): GLUCO STAR INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4703 KNOTTY OAKS TRL
HOUSTON TX
77045-4152
US

IV. Provider business mailing address

4703 KNOTTY OAKS TRL
HOUSTON TX
77045-4152
US

V. Phone/Fax

Practice location:
  • Phone: 713-624-0873
  • Fax: 713-772-9119
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. FELICIA UJU UGHANZE
Title or Position: CEO
Credential:
Phone: 713-624-0873