Healthcare Provider Details

I. General information

NPI: 1417433491
Provider Name (Legal Business Name): ANDYS HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7811 POTOMAC DR
COLORADO SPRINGS CO
80920-7072
US

IV. Provider business mailing address

7811 POTOMAC DR
COLORADO SPRINGS CO
80920-7072
US

V. Phone/Fax

Practice location:
  • Phone: 713-397-0809
  • Fax:
Mailing address:
  • Phone: 713-397-0809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: ELAINE MARIE NEELY
Title or Position: CLINICAL DIRECTOR
Credential: NP
Phone: 281-217-8610