Healthcare Provider Details

I. General information

NPI: 1275853491
Provider Name (Legal Business Name): MONA MENTORS COMMUNITY AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 RICHMOND AVENDUE SUITE 602
HOUSTON TX
77057
US

IV. Provider business mailing address

1339 MACCLESBY LANE
CHANNEVIEW TX
77530
US

V. Phone/Fax

Practice location:
  • Phone: 832-524-7884
  • Fax: 713-266-2090
Mailing address:
  • Phone: 832-524-7884
  • Fax: 713-266-2090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MONA SWAFFORD ELLIS
Title or Position: PRESIDENT
Credential: CRISIS CHAPLAIN
Phone: 832-524-7884