Provider Demographics
NPI:1841993334
Name:AUSPICIOUS COMMUNITY SERVICE LLC
Entity type:Organization
Organization Name:AUSPICIOUS COMMUNITY SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:EKINADUESA
Authorized Official - Last Name:IDUSUYI
Authorized Official - Suffix:
Authorized Official - Credentials:MR
Authorized Official - Phone:225-288-7011
Mailing Address - Street 1:12125 TRAWLER PL
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77568-1628
Mailing Address - Country:US
Mailing Address - Phone:122-528-8701
Mailing Address - Fax:
Practice Address - Street 1:305 FM 517 RD E
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-8612
Practice Address - Country:US
Practice Address - Phone:281-339-7665
Practice Address - Fax:713-583-3613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management