Provider Demographics
NPI:1770648479
Name:NWANGUMA, EBENY CHIKA (OTR)
Entity Type:Individual
Prefix:MR
First Name:EBENY
Middle Name:CHIKA
Last Name:NWANGUMA
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 HONEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-5239
Mailing Address - Country:US
Mailing Address - Phone:832-335-3401
Mailing Address - Fax:281-494-0738
Practice Address - Street 1:3507 HONEY CREEK DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-5239
Practice Address - Country:US
Practice Address - Phone:832-335-3401
Practice Address - Fax:281-494-0738
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities