=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396866299
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PORCHLIGHT HEALTHCARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8300 BISSONNET ST SUITE 222
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77074-3900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-453-7687
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14714 JADE GLEN CT
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77478-1052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-453-7687
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | CHRIS ODUOK
-----------------------------------------------------
Credential | MBA, CALA
-----------------------------------------------------
Telephone | 832-453-7687
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------