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General NPI Number Information
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NPI Number | 1255522751
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Entity Type | Organization
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Legal Business Name | OMNIPOTENT HOME ALWAY FROM HOME INC
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 2626 S LOOP W STE 418
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City | HOUSTON
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State | TX
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Zip | 77054-2648
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Country | US
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Telephone | 713-662-0800
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Fax | 713-662-0801
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Provider Business Mailing Address
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Address Line | 8427 BASSETT ST
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City | HOUSTON
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State | TX
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Zip | 77051-1142
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Country | US
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Telephone | 713-662-0800
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Fax | 713-662-0801
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Authorized Official
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Title or Position | DIRECTOR
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Name | FIDELIA UCHENNA ODILI
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Credential |
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Telephone | 713-662-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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