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General NPI Number Information
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NPI Number | 1295554269
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Entity Type | Organization
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Legal Business Name | WARRIOR SPIRIT
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 5141 CANDLEWOOD DR
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City | LEAGUE CITY
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State | TX
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Zip | 77573-3135
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Country | US
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Telephone | 281-615-2702
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Fax |
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Provider Business Mailing Address
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Address Line | 5141 CANDLEWOOD DR
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City | LEAGUE CITY
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State | TX
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Zip | 77573-3135
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Country | US
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Telephone | 281-615-2702
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GEORGE ONOFRE
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Credential |
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Telephone | 281-615-2702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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