=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215398045
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASC HOME SERVICES AND SENIOR CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2016
-----------------------------------------------------
Last Update Date | 03/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 430 GAMEWOOD DR
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77386-1206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-680-0885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 430 GAMEWOOD DR
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77386-1206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-680-0885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AGENCY ADMINISTRATOR
-----------------------------------------------------
Name | MR. JASPER ESTES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-231-8538
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------