Provider Demographics
NPI:1174689673
Name:VICTOR O UGWA
Entity Type:Organization
Organization Name:VICTOR O UGWA
Other - Org Name:HORIZON HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:UGWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-241-8633
Mailing Address - Street 1:2775 VILLA CREEK DR
Mailing Address - Street 2:STE 123
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7432
Mailing Address - Country:US
Mailing Address - Phone:972-241-8633
Mailing Address - Fax:972-243-5482
Practice Address - Street 1:2775 VILLA CREEK DR
Practice Address - Street 2:STE 123
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7432
Practice Address - Country:US
Practice Address - Phone:972-241-8633
Practice Address - Fax:972-243-5482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008661251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX453162Medicare Oscar/Certification
TX453162Medicare PIN