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General NPI Number Information
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NPI Number | 1952403008
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Entity Type | Organization
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Legal Business Name | FORUM HEALTHCARE CLINIC INC.
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 04/16/2012
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Provider Practice Location Address
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Address Line | 9888 BISSONNET ST STE 680
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City | HOUSTON
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State | TX
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Zip | 77036-8297
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Country | US
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Telephone | 713-778-1210
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Fax | 713-778-1206
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Provider Business Mailing Address
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Address Line | 9888 BISSONNET ST STE 680
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City | HOUSTON
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State | TX
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Zip | 77036-8297
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Country | US
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Telephone | 713-778-1210
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Fax | 713-778-1206
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LILIAN NKEIRUKA IWUANYANWU
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Credential |
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Telephone | 713-778-1210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 010661
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License Number State | TX
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