MEDICARE: FORUM HEALTHCARE CLINIC INC.

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	251E00000X	Home Health Agency	010661	TX

General Provider Information

NPI Number	:	1952403008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORUM HEALTHCARE CLINIC INC.

Provider Business Mailing Address
First Line	:	9888 BISSONNET ST STE 680
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-8297
Country	:	US
Telephone Number	:	713-778-1210
Fax Number	:	713-778-1206

Provider Business Practice Location Address
First Line	:	9888 BISSONNET ST STE 680
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-8297
Country	:	US
Telephone Number	:	713-778-1210
Fax Number	:	713-778-1206

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. LILIAN NKEIRUKA IWUANYANWU
Credential	:
Telephone Number	:	713-778-1210

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	04/16/2012

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