Provider Demographics
NPI:1962559187
Name:GLUCO STAR
Entity type:Organization
Organization Name:GLUCO STAR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:UJU
Authorized Official - Last Name:UGHANZE
Authorized Official - Suffix:
Authorized Official - Credentials:BS (SOCIAL WORK)
Authorized Official - Phone:713-434-8715
Mailing Address - Street 1:4703 KNOTTY OAKS TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-4152
Mailing Address - Country:US
Mailing Address - Phone:713-434-8715
Mailing Address - Fax:713-434-8715
Practice Address - Street 1:4703 KNOTTY OAKS TRL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-4152
Practice Address - Country:US
Practice Address - Phone:713-434-8715
Practice Address - Fax:713-434-8715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPENDIDNG171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty