Healthcare Provider Details

I. General information

NPI: 1174754501
Provider Name (Legal Business Name): WESTRIDGE PINNACLE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 08/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 WESTRIDGE RD
SPRING TX
77380-2844
US

IV. Provider business mailing address

611 WESTRIDGE RD
SPRING TX
77380-2844
US

V. Phone/Fax

Practice location:
  • Phone: 832-456-0001
  • Fax: 832-456-4956
Mailing address:
  • Phone: 832-456-0001
  • Fax: 832-456-4956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. HECTOR IBARRA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 832-456-0001