Healthcare Provider Details

I. General information

NPI: 1154404390
Provider Name (Legal Business Name): LAC HONG ADULT DAY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6628 WILCREST DR STE A
HOUSTON TX
77072-2040
US

IV. Provider business mailing address

6628 WILCREST DR STE A
HOUSTON TX
77072-2040
US

V. Phone/Fax

Practice location:
  • Phone: 281-776-9955
  • Fax:
Mailing address:
  • Phone: 281-776-9955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number116766
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number138387
License Number StateTX

VIII. Authorized Official

Name: KIMSA NGUYEN
Title or Position: DIRECTOR
Credential:
Phone: 281-776-9955