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General NPI Number Information
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NPI Number | 1154085926
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Entity Type | Organization
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Legal Business Name | DOMINION GROOVE INC
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Dates
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Enumeration Date | 10/27/2021
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 3207 CYPRESSWOOD DR
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City | SPRING
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State | TX
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Zip | 77388-5825
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Country | US
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Telephone | 832-275-6712
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Fax | 832-369-1767
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Provider Business Mailing Address
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Address Line | 18623 LANDRUM POINT LN
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City | SPRING
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State | TX
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Zip | 77388-2757
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Country | US
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Telephone | 832-275-6712
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Fax | 832-275-6712
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Authorized Official
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Title or Position | DIRECTOR
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Name | VICTOR ABOLO
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Credential |
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Telephone | 832-275-6712
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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 |
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License Number State |
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