Provider Demographics
NPI:1255196960
Name:WINIFRED I EDOSAH LLC
Entity type:Organization
Organization Name:WINIFRED I EDOSAH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WINIFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:EDOSAH
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:832-335-5514
Mailing Address - Street 1:4534 WYATT ROLAND WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2657
Mailing Address - Country:US
Mailing Address - Phone:832-335-5514
Mailing Address - Fax:
Practice Address - Street 1:4534 WYATT ROLAND WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-2657
Practice Address - Country:US
Practice Address - Phone:832-335-5514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care