MEDICARE: WINIFRED I EDOSAH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1255196960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINIFRED I EDOSAH LLC

Provider Business Mailing Address
First Line	:	4534 WYATT ROLAND WAY
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-2657
Country	:	US
Telephone Number	:	832-335-5514
Fax Number	:

Provider Business Practice Location Address
First Line	:	4534 WYATT ROLAND WAY
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-2657
Country	:	US
Telephone Number	:	832-335-5514
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	WINIFRED EDOSAH
Credential	:	REGISTERED NURSE
Telephone Number	:	832-335-5514

Provider Enumeration Date	:	02/21/2024
Last Update Date	:	07/11/2024

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