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General NPI Number Information
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NPI Number | 1841993334
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Entity Type | Organization
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Legal Business Name | AUSPICIOUS COMMUNITY SERVICE LLC
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Dates
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Enumeration Date | 03/23/2023
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 17300 E CAMINO REAL SUITE 101B
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City | HOUSTON
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State | TX
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Zip | 77058
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Country | US
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Telephone | 281-339-7665
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Fax | 281-863-9461
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Provider Business Mailing Address
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Address Line | 12125 TRAWLER PL
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City | TEXAS CITY
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State | TX
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Zip | 77568-1628
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Country | US
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Telephone | 225-288-7011
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Fax | 281-863-9461
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Authorized Official
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Title or Position | DIRECTOR
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Name | VICTOR EKINADUESA IDUSUYI
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Credential | MR
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Telephone | 225-288-7011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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