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General NPI Number Information
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NPI Number | 1134180201
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Entity Type | Organization
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Legal Business Name | MOTHERLAND, INC.
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 03/16/2012
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Provider Practice Location Address
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Address Line | 4040 YALE ST.
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City | HOUSTON
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State | TX
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Zip | 77018-5928
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Country | US
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Telephone | 713-290-0001
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Fax | 713-290-0023
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Provider Business Mailing Address
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Address Line | 4040 YALE ST.
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City | HOUSTON
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State | TX
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Zip | 77018-5928
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Country | US
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Telephone | 713-290-0001
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Fax | 713-290-0023
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | TIA GIPSON
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Credential |
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Telephone | 713-290-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State | TX
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