=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124300140
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BECAUSE I CARE ADULT DAY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2011
-----------------------------------------------------
Last Update Date | 09/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24803 LAZY TEE LN
-----------------------------------------------------
City | TOMBALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77375-1120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-481-9565
-----------------------------------------------------
Fax | 713-481-9561
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8450
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77288-8450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-481-9565
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF ADMINISTRATION
-----------------------------------------------------
Name | DENISE BRADFORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-384-9769
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305R00000X
-----------------------------------------------------
Taxonomy Name | Preferred Provider Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------