Healthcare Provider Details

I. General information

NPI: 1174247126
Provider Name (Legal Business Name): SUPPORTIVE CARE OF TEXAS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 09/11/2025
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W CENTERVILLE RD
GARLAND TX
75041-5445
US

IV. Provider business mailing address

27 RANDOLPH RD
HOWELL NJ
07731-8611
US

V. Phone/Fax

Practice location:
  • Phone: 718-298-2753
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROBERT GLENN
Title or Position: DIRECTOR
Credential:
Phone: 718-298-4375