Provider Demographics
NPI:1609369172
Name:COMMUNITY HEALTH AND LIFE CENTER, PLLC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH AND LIFE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:NWACHOKOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:281-615-6466
Mailing Address - Street 1:17510 W GRAND PKWY S STE 380
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17510 W GRAND PKWY S STE 380
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2649
Practice Address - Country:US
Practice Address - Phone:281-615-6466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-10
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1992182398Medicaid