Healthcare Provider Details

I. General information

NPI: 1972200251
Provider Name (Legal Business Name): RUSSO CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17302 HOUSE HAHL RD STE 207
CYPRESS TX
77433-8213
US

IV. Provider business mailing address

PO BOX 1394
CYPRESS TX
77410-1394
US

V. Phone/Fax

Practice location:
  • Phone: 281-607-1370
  • Fax: 832-582-3647
Mailing address:
  • Phone: 281-607-1370
  • Fax: 832-582-3647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRITTNEY RUSSO
Title or Position: PRESIDENT
Credential:
Phone: 281-607-1370