Provider Demographics
NPI:1568798882
Name:IDEAL FAMILY WELLNESS
Entity Type:Organization
Organization Name:IDEAL FAMILY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHILAKA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:832-834-4394
Mailing Address - Street 1:7447 HARWIN DR
Mailing Address - Street 2:#104
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2016
Mailing Address - Country:US
Mailing Address - Phone:832-834-4394
Mailing Address - Fax:832-834-4401
Practice Address - Street 1:7447 HARWIN DR
Practice Address - Street 2:#104
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2016
Practice Address - Country:US
Practice Address - Phone:832-834-4394
Practice Address - Fax:832-834-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX728821163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX728821OtherRN LICENSE #