Provider Demographics
NPI:1760646061
Name:ST NICHOLAS, INC
Entity Type:Organization
Organization Name:ST NICHOLAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NWABUOGO
Authorized Official - Middle Name:
Authorized Official - Last Name:ANAGBOGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-991-5322
Mailing Address - Street 1:9222 CARMALEE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-4909
Mailing Address - Country:US
Mailing Address - Phone:713-991-5322
Mailing Address - Fax:
Practice Address - Street 1:9222 CARMALEE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-4909
Practice Address - Country:US
Practice Address - Phone:713-991-5322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities