Healthcare Provider Details

I. General information

NPI: 1215545751
Provider Name (Legal Business Name): FULLILOVE PRREGNANCY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 E TC JESTER BLVD APT 1123
HOUSTON TX
77008-2579
US

IV. Provider business mailing address

1640 E TC JESTER BLVD APT 1123
HOUSTON TX
77008-2579
US

V. Phone/Fax

Practice location:
  • Phone: 816-977-7153
  • Fax:
Mailing address:
  • Phone: 816-977-7153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CESLEY FULLILOVE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 816-977-7153