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General NPI Number Information
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NPI Number | 1508782905
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Entity Type | Organization
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Legal Business Name | LIFETIME WELLNESS COMMUNITY OUTREACH LLC
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Dates
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Enumeration Date | 06/29/2026
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Last Update Date | 07/01/2026
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Provider Practice Location Address
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Address Line | 14809 RALSTON RD
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City | HUMBLE
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State | TX
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Zip | 77396-5142
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Country | US
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Telephone | 214-709-5615
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Fax |
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Provider Business Mailing Address
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Address Line | 1337 W 43RD ST UNIT 1121
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City | HOUSTON
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State | TX
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Zip | 77018-4202
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHW/COMMUNITY HEALTH WORKER
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Name | MR. OSAZE IDUMWONYI
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Credential |
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Telephone | 214-709-5615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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