Provider Demographics
NPI:1275890550
Name:HAILU, HIRUT
Entity Type:Individual
Prefix:
First Name:HIRUT
Middle Name:
Last Name:HAILU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9809 RICHMOND AVE
Mailing Address - Street 2:UNIT # G7
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-4563
Mailing Address - Country:US
Mailing Address - Phone:713-823-3824
Mailing Address - Fax:
Practice Address - Street 1:9809 RICHMOND AVE
Practice Address - Street 2:UNIT # G7
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4563
Practice Address - Country:US
Practice Address - Phone:713-823-3824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities