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General NPI Number Information
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NPI Number | 1013157445
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Entity Type | Organization
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Legal Business Name | THE HOUSTON VICTORIOUS LIVING CHURCH
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Dates
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Enumeration Date | 02/25/2009
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Last Update Date | 02/25/2009
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Provider Practice Location Address
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Address Line | 5314 BRANSFORD ROAD
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City | COLLEYVILLE
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State | TX
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Zip | 76034
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Country | US
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Telephone | 817-427-2273
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Fax | 817-503-1960
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Provider Business Mailing Address
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Address Line | 5314 BRANSFORD RD
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City | COLLEYVILLE
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State | TX
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Zip | 76034-3530
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICHARD L RAY SR.
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Credential |
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Telephone | 817-427-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 126015
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License Number State | TX
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