Provider Demographics
NPI:1538467865
Name:IWUH, JOSEPHINE EUDES (NA)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:EUDES
Last Name:IWUH
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 SONOMA WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77053-4347
Mailing Address - Country:US
Mailing Address - Phone:248-275-6169
Mailing Address - Fax:
Practice Address - Street 1:6211 SONOMAWAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77053-4347
Practice Address - Country:US
Practice Address - Phone:248-275-6169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27781583315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities