Provider Demographics
NPI:1467992065
Name:ELIZABETH EVBUOMWAN
Entity Type:Organization
Organization Name:ELIZABETH EVBUOMWAN
Other - Org Name:EXCEL PLUS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DON
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:EVBUOMWAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-550-8516
Mailing Address - Street 1:5601 BONHOMME RD STE B2
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2044
Mailing Address - Country:US
Mailing Address - Phone:281-550-8516
Mailing Address - Fax:281-463-0283
Practice Address - Street 1:5601 BONHOMME RD STE B2
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2044
Practice Address - Country:US
Practice Address - Phone:281-550-8516
Practice Address - Fax:281-463-0283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6564123140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX205863801Medicaid
TX205863801Medicaid