Provider Demographics
NPI:1558696187
Name:METROCARE WELLNESS CENTER INC
Entity Type:Organization
Organization Name:METROCARE WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EGHOSA
Authorized Official - Middle Name:
Authorized Official - Last Name:AIDEYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-763-4822
Mailing Address - Street 1:11040 EAST FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77029-1931
Mailing Address - Country:US
Mailing Address - Phone:305-763-4822
Mailing Address - Fax:
Practice Address - Street 1:11040 EAST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-1931
Practice Address - Country:US
Practice Address - Phone:305-763-4822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health