Provider Demographics
NPI:1336326594
Name:OMENUKO HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:OMENUKO HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHUKWUEMEKA
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:NWANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-866-9910
Mailing Address - Street 1:241 JEROME ST
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5403
Mailing Address - Country:US
Mailing Address - Phone:347-866-9910
Mailing Address - Fax:
Practice Address - Street 1:1421 CROSS COURTS DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-7535
Practice Address - Country:US
Practice Address - Phone:347-866-9910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32070000X320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities