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General NPI Number Information
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NPI Number | 1376712455
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Entity Type | Organization
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Legal Business Name | MADIE ENTERPRISE INC DBA OLD YALE ADULT DAY CARE
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4414 OLD YALE ST
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City | HOUSTON
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State | TX
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Zip | 77018-4506
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Country | US
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Telephone | 713-695-6100
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Fax | 713-695-6349
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Provider Business Mailing Address
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Address Line | 4414 OLD YALE ST
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City | HOUSTON
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State | TX
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Zip | 77018-4506
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Country | US
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Telephone | 713-695-6100
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Fax | 713-695-6349
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Authorized Official
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Title or Position | CEO
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Name | MR. JOHNNY GAYLON HOLLINS
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Credential |
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Telephone | 713-695-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | TX
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