Healthcare Provider Details

I. General information

NPI: 1447752225
Provider Name (Legal Business Name): EZ LIVING ADULT DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 E MAIN ST STE B
HUMBLE TX
77338-4749
US

IV. Provider business mailing address

9307 DUNE GATE CT
HUMBLE TX
77396-1680
US

V. Phone/Fax

Practice location:
  • Phone: 832-903-3590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HATTIE HOLCOMBE
Title or Position: ADMINISTRATOR
Credential:
Phone: 832-903-3590