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General NPI Number Information
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NPI Number | 1083969562
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Entity Type | Organization
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Legal Business Name | STADIUM EMERGENCY SHELTER
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Dates
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Enumeration Date | 07/19/2012
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 21882 E WALLIS DR
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City | PORTER
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State | TX
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Zip | 77365-5366
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Country | US
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Telephone | 832-436-1596
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Fax |
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Provider Business Mailing Address
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Address Line | 21882 E WALLIS DR
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City | PORTER
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State | TX
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Zip | 77365-5366
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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 | SECRETARY
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Name | MS. RITA J. TRYON
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Credential |
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Telephone | 713-624-0025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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