=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275871790
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXCLUSIVE COMFORT CAREGIVERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2013
-----------------------------------------------------
Last Update Date | 01/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3727 GREENBRIAR DR SUITE 115
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77477-3954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-304-4424
-----------------------------------------------------
Fax | 832-304-4425
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1707 POST OAK BLVD SUITE 232
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77056-3801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-505-4200
-----------------------------------------------------
Fax | 832-304-4425
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/OWNER
-----------------------------------------------------
Name | MR. ERROL ELLIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-505-4200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------