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General NPI Number Information
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NPI Number | 1962559187
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Entity Type | Organization
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Legal Business Name | GLUCO STAR
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4703 KNOTTY OAKS TRL
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City | HOUSTON
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State | TX
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Zip | 77045-4152
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Country | US
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Telephone | 713-434-8715
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Fax | 713-434-8715
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Provider Business Mailing Address
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Address Line | 4703 KNOTTY OAKS TRL
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City | HOUSTON
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State | TX
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Zip | 77045-4152
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Country | US
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Telephone | 713-434-8715
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Fax | 713-434-8715
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Authorized Official
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Title or Position | C.E.O
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Name | MRS. FELICIA UJU UGHANZE
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Credential | BS (SOCIAL WORK)
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Telephone | 713-434-8715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | PENDIDNG
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License Number State | TX
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