Provider Demographics
NPI:1548856321
Name:CHICHI LIVING CENTER LLC
Entity type:Organization
Organization Name:CHICHI LIVING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHISOM
Authorized Official - Middle Name:U
Authorized Official - Last Name:IKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-409-0685
Mailing Address - Street 1:9119 S GESSNER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2845
Mailing Address - Country:US
Mailing Address - Phone:713-771-1550
Mailing Address - Fax:
Practice Address - Street 1:9119 S GESSNER RD STE 201
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2845
Practice Address - Country:US
Practice Address - Phone:713-771-1550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74-2638006Medicaid