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General NPI Number Information
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NPI Number | 1336326594
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Entity Type | Organization
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Legal Business Name | OMENUKO HEALTHCARE SERVICES
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 1421 CROSS COURTS DR
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City | GARLAND
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State | TX
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Zip | 75040-7535
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Country | US
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Telephone | 347-866-9910
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Fax |
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Provider Business Mailing Address
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Address Line | 241 JEROME ST
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City | SYOSSET
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State | NY
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Zip | 11791-5403
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Country | US
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Telephone | 347-866-9910
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | CHUKWUEMEKA DONALD NWANA
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Credential |
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Telephone | 347-866-9910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 32070000X
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License Number State | TX
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