Healthcare Provider Details

I. General information

NPI: 1164665303
Provider Name (Legal Business Name): SOLACIUM FULSHEAR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10514 OBERRENDER RD
NEEDVILLE TX
77461-5700
US

IV. Provider business mailing address

5500 MING AVE STE 410
BAKERSFIELD CA
93309-4631
US

V. Phone/Fax

Practice location:
  • Phone: 979-793-3014
  • Fax:
Mailing address:
  • Phone: 661-622-4132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SHARNELL SPENCER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 661-239-6923