Provider Demographics
NPI:1720860893
Name:ISAAC CHUKWUMA OHALETE
Entity Type:Organization
Organization Name:ISAAC CHUKWUMA OHALETE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:OHALETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-455-2242
Mailing Address - Street 1:2104 RINCON DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-1569
Mailing Address - Country:US
Mailing Address - Phone:281-455-2242
Mailing Address - Fax:
Practice Address - Street 1:1002 GEMINI ST STE 136A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2746
Practice Address - Country:US
Practice Address - Phone:832-792-8252
Practice Address - Fax:281-346-9988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities