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General NPI Number Information
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NPI Number | 1053992487
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Entity Type | Organization
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Legal Business Name | ROAD TO RICKS CARE LLC
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Dates
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Enumeration Date | 04/17/2021
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Last Update Date | 04/17/2021
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Provider Practice Location Address
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Address Line | 2300 OLD SPANISH TRL APT 1136
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City | HOUSTON
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State | TX
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Zip | 77054-2170
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Country | US
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Telephone | 908-627-2901
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 OLD SPANISH TRL APT 1136
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City | HOUSTON
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State | TX
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Zip | 77054-2170
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Country | US
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Telephone | 908-627-2901
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/CEO
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Name | KEENA K RICKS
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Credential |
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Telephone | 908-627-2901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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