Healthcare Provider Details

I. General information

NPI: 1578823936
Provider Name (Legal Business Name): AN INDEPENDENT ME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2012
Last Update Date: 05/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 E WHITESTONE BLVD
CEDAR PARK TX
78613-6930
US

IV. Provider business mailing address

14900 AVERY RANCH BLVD C200 #266
AUSTIN TX
78717-3951
US

V. Phone/Fax

Practice location:
  • Phone: 512-656-6364
  • Fax:
Mailing address:
  • Phone: 512-656-6364
  • Fax: 512-716-1193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA CURETON DAY
Title or Position: PRESIDENT
Credential:
Phone: 512-656-6364