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General NPI Number Information
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NPI Number | 1326354515
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Entity Type | Organization
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Legal Business Name | PRAC
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Dates
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Enumeration Date | 08/25/2010
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Last Update Date | 08/25/2010
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Provider Practice Location Address
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Address Line | 23715 AYSCOUGH LN
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City | KATY
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State | TX
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Zip | 77493-3419
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Country | US
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Telephone | 281-236-7061
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Fax |
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Provider Business Mailing Address
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Address Line | 23715 AYSCOUGH LN
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City | KATY
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State | TX
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Zip | 77493-3419
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Country | US
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Telephone | 281-236-7061
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CARMEN E EULIRATE
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Credential |
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Telephone | 281-236-7061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | 07344684
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License Number State | TX
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