Organization
PHENOMENAL OUTREACH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY HELEN JACKSON (OWNER/PROGRAM MANAGER)
(832) 877-2207
Entity
Organization
Contact information
Practice address
6102 LAURA KOPPE RD, HOUSTON, TX 77016-5440
(832) 877-2207
Mailing address
6102 LAURA KOPPE RD, HOUSTON, TX 77016-5440
(832) 877-2207
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
TX
Other
Enumeration date
10/29/2011
Last updated
11/07/2011
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