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General NPI Number Information
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NPI Number | 1184951063
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Entity Type | Organization
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Legal Business Name | LIFE ADULT DAYCARE PROGRAM
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8514 C E KING PKWY SUITE G
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City | HOUSTON
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State | TX
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Zip | 77044-2344
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Country | US
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Telephone | 832-435-0080
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Fax |
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Provider Business Mailing Address
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Address Line | 8514 C E KING PKWY SUITE G
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City | HOUSTON
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State | TX
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Zip | 77044-2344
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Country | US
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Telephone | 832-435-0080
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Fax |
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Authorized Official
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Title or Position | CHIEF ADMINISTRATOR
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Name | MR. KHARI RAHSHON SINGLETON
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Credential |
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Telephone | 832-435-0080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 01-0926505
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License Number State | TX
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