Healthcare Provider Details

I. General information

NPI: 1437819000
Provider Name (Legal Business Name): IGNITE MEDICAL RESORT WEBSTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2021
Last Update Date: 12/23/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16130 GALVESTON RD
WEBSTER TX
77598
US

IV. Provider business mailing address

1550 N NORTHWEST HWY STE 430
PARK RIDGE IL
60068-1461
US

V. Phone/Fax

Practice location:
  • Phone: 832-426-7030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BARRY CARR
Title or Position: MEMBER
Credential:
Phone: 312-218-2000