Provider Demographics
NPI:1063623726
Name:FOUR J'S COMMUNITY LIVING CENTERS, INC.
Entity type:Organization
Organization Name:FOUR J'S COMMUNITY LIVING CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:UDUMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-981-6206
Mailing Address - Street 1:PO BOX 770159
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77215-0159
Mailing Address - Country:US
Mailing Address - Phone:713-981-6206
Mailing Address - Fax:
Practice Address - Street 1:9207 COUNTRY CREEK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7714
Practice Address - Country:US
Practice Address - Phone:713-981-6206
Practice Address - Fax:713-981-6839
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:N/A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1063623726Medicaid