Provider Demographics
NPI:1265274419
Name:JEWELECHE LLC
Entity type:Organization
Organization Name:JEWELECHE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:EBIGWU
Authorized Official - Last Name:DIBIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-679-5264
Mailing Address - Street 1:3003 WINDCHASE BLVD APT 1204
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-3446
Mailing Address - Country:US
Mailing Address - Phone:832-679-5264
Mailing Address - Fax:
Practice Address - Street 1:3003 WINDCHASE BLVD APT 1204
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-3446
Practice Address - Country:US
Practice Address - Phone:832-679-5264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities