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General NPI Number Information
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NPI Number | 1922353945
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Entity Type | Organization
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Legal Business Name | IFEYINWA ODU
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Dates
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Enumeration Date | 07/16/2012
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Last Update Date | 07/16/2012
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Provider Practice Location Address
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Address Line | 6430 RICHMOND AVE SUITE # 370
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City | HOUSTON
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State | TX
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Zip | 77057-5917
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Country | US
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Telephone | 713-530-6785
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Fax |
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Provider Business Mailing Address
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Address Line | 6430 RICHMOND AVE 370
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City | HOUSTN
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State | TX
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Zip | 77057-5017
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Country | US
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Telephone | 713-530-6785
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. IFEYINWA ODU
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Credential | B.B.A
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Telephone | 713-530-6785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 013777
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License Number State | TX
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