Healthcare Provider Details

I. General information

NPI: 1508307661
Provider Name (Legal Business Name): ICE CARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11510 ROCKFORD DR
HOUSTON TX
77048-2615
US

IV. Provider business mailing address

11510 ROCKFORD DR
HOUSTON TX
77048-2615
US

V. Phone/Fax

Practice location:
  • Phone: 281-781-9985
  • Fax:
Mailing address:
  • Phone: 281-781-9985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. DORIS ROBINSON PIERT
Title or Position: ADMINISTRATOR
Credential:
Phone: 281-781-9985