Healthcare Provider Details

I. General information

NPI: 1811171663
Provider Name (Legal Business Name): NICK KNOX JR.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7034 BALLINGER RIDGE LN
RICHMOND TX
77469-4058
US

IV. Provider business mailing address

7034 BALLINGER RIDGE LN
RICHMOND TX
77469-4058
US

V. Phone/Fax

Practice location:
  • Phone: 832-272-4799
  • Fax:
Mailing address:
  • Phone: 832-272-4799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. NICK KNOX JR.
Title or Position: CEO
Credential: N/A
Phone: 832-272-4799