Provider Demographics
NPI:1952403008
Name:FORUM HEALTHCARE CLINIC INC.
Entity Type:Organization
Organization Name:FORUM HEALTHCARE CLINIC INC.
Other - Org Name:NA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILIAN
Authorized Official - Middle Name:NKEIRUKA
Authorized Official - Last Name:IWUANYANWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-778-1210
Mailing Address - Street 1:9888 BISSONNET ST STE 680
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8297
Mailing Address - Country:US
Mailing Address - Phone:713-778-1210
Mailing Address - Fax:713-778-1206
Practice Address - Street 1:9888 BISSONNET ST STE 680
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8297
Practice Address - Country:US
Practice Address - Phone:713-778-1210
Practice Address - Fax:713-778-1206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010661251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health