=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336438928
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOSPICE CARE OF WEST HOUSTON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2011
-----------------------------------------------------
Last Update Date | 04/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7223 GRANTS HOLLOW LN
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77407-3992
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-419-0989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7223 GRANTS HOLLOW LN
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77407-3992
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-419-0989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. NICOLE DENISE STEWART
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-545-8646
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------