Healthcare Provider Details

I. General information

NPI: 1851750244
Provider Name (Legal Business Name): SPREAD YOUR WINGS ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 BAYOU ST
HOUSTON TX
77020-8202
US

IV. Provider business mailing address

1123 HEATHFIELD DR
CHANNELVIEW TX
77530-2337
US

V. Phone/Fax

Practice location:
  • Phone: 281-864-5462
  • Fax: 281-864-5462
Mailing address:
  • Phone: 281-864-5462
  • Fax: 281-864-5462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number136493
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number136493
License Number StateTX

VIII. Authorized Official

Name: PATRICIA ALLS ALLS
Title or Position: OWNER
Credential: L.V.N.
Phone: 832-523-5315