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General NPI Number Information
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NPI Number | 1124497938
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Entity Type | Organization
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Legal Business Name | UNCONDITIONAL CARE SERVICES
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 09/22/2015
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Provider Practice Location Address
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Address Line | 2616 S LOOP W #218
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City | HOUSTON
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State | TX
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Zip | 77054-2662
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Country | US
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Telephone | 770-655-7072
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Fax |
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Provider Business Mailing Address
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Address Line | 2616 S LOOP W #218
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City | HOUSTON
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State | TX
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Zip | 77054-2662
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Country | US
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Telephone | 770-655-7072
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MR. ANDRE D GARRISON
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Credential | M.S., LCDC
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Telephone | 770-655-7072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 3908-3909
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License Number State | TX
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