Provider Demographics
NPI:1255594149
Name:AMAECHI, JUSTICE JOLLY
Entity type:Individual
Prefix:MR
First Name:JUSTICE
Middle Name:JOLLY
Last Name:AMAECHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20322 MATHIS LANDING DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-6178
Mailing Address - Country:US
Mailing Address - Phone:281-213-3315
Mailing Address - Fax:281-213-3315
Practice Address - Street 1:20322 MATHIS LANDING DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-6178
Practice Address - Country:US
Practice Address - Phone:281-213-3315
Practice Address - Fax:281-213-3315
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2072068Medicaid