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General NPI Number Information
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NPI Number | 1124195524
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Entity Type | Organization
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Legal Business Name | INDIVIDUAL CARE OF TEXAS, INC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1655 P.R. 2530
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City | QUINLAN
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State | TX
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Zip | 75474-1810
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Country | US
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Telephone | 903-356-4526
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Fax | 903-356-4544
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Provider Business Mailing Address
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Address Line | P O BOX 1419
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City | ROCKWALL
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State | TX
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Zip | 75087-1419
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Country | US
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Telephone | 972-771-2350
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Fax | 972-771-4860
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | SANDRA E PETERSEN
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Credential |
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Telephone | 972-771-2350
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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 | 115880
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License Number State | TX
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