Organization
MOTHERLAND, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VICTOR NDANDO-NGOO (CEO/FOUNDER)
(713) 290-0001
Entity
Organization
Contact information
Practice address
4040 YALE ST, HOUSTON, TX 77018-5928
(713) 290-0001
(713) 290-0023
Mailing address
4040 YALE ST, HOUSTON, TX 77018-5928
(713) 290-0001
(713) 290-0023
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
540680
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00Z744
MEDICARE PART B
TX
05
—
199525002
—
TX
01
—
671926
MEDICARE PART A
TX
Enumeration date
05/02/2011
Last updated
05/02/2011
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