Provider Demographics
NPI:1821382359
Name:FAMILY SUREHEALTH CLINIC LLC
Entity Type:Organization
Organization Name:FAMILY SUREHEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SCHOLASTICA
Authorized Official - Middle Name:NNENNA
Authorized Official - Last Name:NWODO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:832-755-7805
Mailing Address - Street 1:10101 BISSONNET ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7855
Mailing Address - Country:US
Mailing Address - Phone:281-888-9458
Mailing Address - Fax:281-888-4654
Practice Address - Street 1:10101 BISSONNET ST
Practice Address - Street 2:SUITE 105
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7855
Practice Address - Country:US
Practice Address - Phone:281-888-9458
Practice Address - Fax:281-888-4654
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY SUREHEALTH CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX609245363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty