Provider Demographics
NPI:1649354507
Name:JUDITH C. NWOKORIE
Entity type:Organization
Organization Name:JUDITH C. NWOKORIE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:C
Authorized Official - Last Name:NWOKORIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-988-2618
Mailing Address - Street 1:PO BOX 2236
Mailing Address - Street 2:
Mailing Address - City:ALIEF
Mailing Address - State:TX
Mailing Address - Zip Code:77411
Mailing Address - Country:US
Mailing Address - Phone:713-988-2618
Mailing Address - Fax:713-988-2619
Practice Address - Street 1:9894 BISSONNET ST STE 290
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8285
Practice Address - Country:US
Practice Address - Phone:713-988-2618
Practice Address - Fax:713-988-2619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009835251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679518Medicare PIN