=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013067925
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HELEN IGIEBOR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 04/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10039 BISSONNET ST STE 314
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-7840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-771-5665
-----------------------------------------------------
Fax | 713-771-5690
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10039 BISSONNET ST STE 314
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-7840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-771-5665
-----------------------------------------------------
Fax | 713-771-5690
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. HELEN IGIEBOR
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 713-771-5665
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 008893
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------