Provider Demographics
NPI:1902941123
Name:NKECHI AHANOTU
Entity Type:Organization
Organization Name:NKECHI AHANOTU
Other - Org Name:STAR HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NKECHI
Authorized Official - Middle Name:E
Authorized Official - Last Name:AHANOTU-ANIGBOGU
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:713-218-7099
Mailing Address - Street 1:2646 SOUTH LOOP W
Mailing Address - Street 2:SUITE 355
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2665
Mailing Address - Country:US
Mailing Address - Phone:713-218-7099
Mailing Address - Fax:713-218-6772
Practice Address - Street 1:2646 SOUTH LOOP W
Practice Address - Street 2:SUITE 355
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2665
Practice Address - Country:US
Practice Address - Phone:713-218-7099
Practice Address - Fax:713-218-6772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008197251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001013488Medicaid
TX679394Medicare Oscar/Certification
TX001013488Medicaid