Provider Demographics
NPI:1578779856
Name:HOUSTON MAINTENANCE CLINIC, INC
Entity Type:Organization
Organization Name:HOUSTON MAINTENANCE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:OZUMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-527-0064
Mailing Address - Street 1:4608 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-9714
Mailing Address - Country:US
Mailing Address - Phone:713-527-0064
Mailing Address - Fax:713-527-8633
Practice Address - Street 1:4608 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9714
Practice Address - Country:US
Practice Address - Phone:713-527-0064
Practice Address - Fax:713-527-8633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0000032101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX454713Medicare ID - Type Unspecified