Healthcare Provider Details

I. General information

NPI: 1114821238
Provider Name (Legal Business Name): LITTLE GRAY ROSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3507 WARWICK RIVER TRL
PORTER TX
77365-7358
US

IV. Provider business mailing address

3507 WARWICK RIVER TRL
PORTER TX
77365-7358
US

V. Phone/Fax

Practice location:
  • Phone: 832-800-3879
  • Fax:
Mailing address:
  • Phone: 832-800-3879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: BIANCA ST JULIAN
Title or Position: CO-FOUNDER/OWNER
Credential:
Phone: 832-305-5670