Provider Demographics
NPI:1760708820
Name:SIMEON ANUGWOM
Entity Type:Organization
Organization Name:SIMEON ANUGWOM
Other - Org Name:SIDA HEALTH CARE AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CASE WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:INNOCENT
Authorized Official - Middle Name:DAMIAN
Authorized Official - Last Name:ANUGWOM
Authorized Official - Suffix:
Authorized Official - Credentials:BBA, MPA
Authorized Official - Phone:832-594-3188
Mailing Address - Street 1:5411 RIDGE WIND LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77053-5223
Mailing Address - Country:US
Mailing Address - Phone:832-594-3188
Mailing Address - Fax:281-565-1484
Practice Address - Street 1:5411 RIDGE WIND LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77053-5223
Practice Address - Country:US
Practice Address - Phone:832-594-3188
Practice Address - Fax:281-565-1484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSIMEON3975Medicaid