MEDICARE: JUSTINA OBY UZOWULU MANAGER

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	3104A0630X	Assisted Living Facility (Behavioral Disturbances)	101891	TX

General Provider Information

NPI Number	:	1952526055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINA OBY UZOWULU MANAGER

Provider Business Mailing Address
First Line	:	11502 HORNBROOK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-4144
Country	:	US
Telephone Number	:	281-988-8648
Fax Number	:	281-530-3590

Provider Business Practice Location Address
First Line	:	11502 HORNBROOK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-4144
Country	:	US
Telephone Number	:	281-988-8648
Fax Number	:	281-530-3590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/08/2007

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