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General NPI Number Information
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NPI Number | 1023399508
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Entity Type | Organization
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Legal Business Name | NW CONVENIENCE HEALTH CARE, LLC
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 13656 BRETON RIDGE ST SUITE C
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City | HOUSTON
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State | TX
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Zip | 77070-6081
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Country | US
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Telephone | 832-678-5881
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Fax | 832-678-5882
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Provider Business Mailing Address
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Address Line | 13656 BRETON RIDGE ST SUITE C
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City | HOUSTON
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State | TX
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Zip | 77070-6081
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Country | US
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Telephone | 832-678-5881
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Fax | 832-678-5882
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Authorized Official
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Title or Position | OWNER
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Name | MR. TRAEVIS ANDERSON
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Credential |
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Telephone | 832-678-5881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 014578
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License Number State | TX
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