Healthcare Provider Details

I. General information

NPI: 1982913703
Provider Name (Legal Business Name): NANCY J. DAVIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 RAVENSWORTH DR
HOUSTON TX
77031-3130
US

IV. Provider business mailing address

9750 RAVENSWORTH DR
HOUSTON TX
77031-3130
US

V. Phone/Fax

Practice location:
  • Phone: 281-530-2122
  • Fax:
Mailing address:
  • Phone: 281-530-2122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite 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. NANCY JERRELL DAVIS
Title or Position: OWNER/PROGRAM MANAGER
Credential: RN
Phone: 281-530-2122