Healthcare Provider Details

I. General information

NPI: 1891989828
Provider Name (Legal Business Name): ADULT TOWN DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2007
Last Update Date: 09/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 S WAYSIDE DR STE 105
HOUSTON TX
77087-1126
US

IV. Provider business mailing address

4450 S WAYSIDE DR STE 105
HOUSTON TX
77087-1126
US

V. Phone/Fax

Practice location:
  • Phone: 713-645-2300
  • Fax:
Mailing address:
  • Phone: 713-645-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number003319
License Number StateTX

VIII. Authorized Official

Name: MUSIBAU LAYENI
Title or Position: PRESIDENT
Credential:
Phone: 713-645-2300