Healthcare Provider Details

I. General information

NPI: 1992107601
Provider Name (Legal Business Name): INDEPENDENT ACRES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 E 32ND ST
HOUSTON TX
77018-7703
US

IV. Provider business mailing address

219 E 32ND ST
HOUSTON TX
77018-7703
US

V. Phone/Fax

Practice location:
  • Phone: 713-829-7347
  • Fax:
Mailing address:
  • Phone: 713-829-7347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. SEDRICK BRADLEY
Title or Position: PRESIDENT
Credential:
Phone: 713-829-7347