Provider Demographics
NPI:1710285176
Name:ORIGIN HEALTHCARE INC
Entity Type:Organization
Organization Name:ORIGIN HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IJEOMA
Authorized Official - Middle Name:O
Authorized Official - Last Name:ODUMODU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-885-0161
Mailing Address - Street 1:10227 SUGARBRIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-4075
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10227 SUGARBRIDGE TRL
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-4075
Practice Address - Country:US
Practice Address - Phone:832-885-0161
Practice Address - Fax:281-564-7326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health