Provider Demographics
NPI:1497797732
Name:WEST WYNDE HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:WEST WYNDE HEALTH SERVICES INC.
Other - Org Name:WEST WYNDE HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:ORAGWU
Authorized Official - Last Name:IBIK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-972-1902
Mailing Address - Street 1:4707 KNIGHTS BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5335
Mailing Address - Country:US
Mailing Address - Phone:713-972-1902
Mailing Address - Fax:713-972-0272
Practice Address - Street 1:6201 BONHOMME RD
Practice Address - Street 2:264
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4365
Practice Address - Country:US
Practice Address - Phone:713-972-1902
Practice Address - Fax:713-972-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007637251E00000X
TX010643251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001014829Medicaid
TX001014828Medicaid
TX010643OtherL&CHHS, LHHS, PAS
TX679210Medicare Oscar/Certification
TX001014828Medicaid