Healthcare Provider Details

I. General information

NPI: 1508332545
Provider Name (Legal Business Name): ROTELLA ADULT DAY & ACTIVITY CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7911 PINE HEATH CT
HUMBLE TX
77396-4300
US

IV. Provider business mailing address

7307 CRESCENT BRIDGE CT
HUMBLE TX
77396-1686
US

V. Phone/Fax

Practice location:
  • Phone: 281-616-5225
  • Fax: 713-583-8455
Mailing address:
  • Phone: 281-616-5225
  • Fax: 713-583-8455

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: MS. FHYLLIS SHEIDUN
Title or Position: ADMINISTRATOR
Credential:
Phone: 281-616-5225