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General NPI Number Information
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NPI Number | 1265746135
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Entity Type | Organization
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Legal Business Name | HOLD ON FAITHFULLY
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 08/03/2010
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Provider Practice Location Address
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Address Line | 15506 HOLLOW CYPRESS CT
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City | HOUSTON
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State | TX
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Zip | 77049-2526
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Country | US
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Telephone | 713-775-0254
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Fax |
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Provider Business Mailing Address
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Address Line | 15506 HOLLOW CYPRESS COURT
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City | HOUSTON
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State | TX
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Zip | 77049
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Country | US
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Telephone | 713-775-0254
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Fax |
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Authorized Official
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Title or Position | MANAGER /LVN
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Name | MRS. SHAUNTA LA'FAYE BONNER
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Credential |
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Telephone | 713-775-0254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 196755
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License Number State | TX
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