Healthcare Provider Details

I. General information

NPI: 1902440407
Provider Name (Legal Business Name): SALTER ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7927 CLAIBORNE ST
HOUSTON TX
77078-2103
US

IV. Provider business mailing address

PO BOX 23812
HOUSTON TX
77228-3812
US

V. Phone/Fax

Practice location:
  • Phone: 503-457-1696
  • Fax: 713-491-2103
Mailing address:
  • Phone: 503-457-1696
  • Fax: 713-491-2103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TOYNA EVETTE SALTER
Title or Position: OWNER
Credential:
Phone: 503-457-1696