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General NPI Number Information
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NPI Number | 1205039203
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Entity Type | Organization
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Legal Business Name | CHARLES HOLT
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3117 ROYAL ST
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City | BAYTOWN
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State | TX
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Zip | 77521-1111
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Country | US
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Telephone | 281-426-7913
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Fax |
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Provider Business Mailing Address
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Address Line | 3128 ROYAL ST
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City | BAYTOWN
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State | TX
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Zip | 77521-1112
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Country | US
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Telephone | 281-426-7913
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CHARLES HOWARD HOLT
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Credential |
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Telephone | 281-426-7913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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