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General NPI Number Information
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NPI Number | 1073856985
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Entity Type | Organization
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Legal Business Name | PERSAD, INC.
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Dates
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Enumeration Date | 03/28/2013
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Last Update Date | 08/27/2013
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Provider Practice Location Address
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Address Line | 1016 LA MIRADA
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City | PORTLAND
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State | TX
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Zip | 78374-4132
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Country | US
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Telephone | 361-230-9362
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Fax | 888-708-5069
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Provider Business Mailing Address
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Address Line | PO BOX 1331
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City | PORTLAND
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State | TX
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Zip | 78374-1185
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Country | US
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Telephone | 361-230-9362
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Fax | 888-708-5069
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Authorized Official
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Title or Position | PRESIDENT/DIRECTOR
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Name | MRS. KIMBERLY RENE PERSAD
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Credential | RN, BSN
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Telephone | 361-230-9362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 015622
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License Number State | TX
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