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General NPI Number Information
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NPI Number | 1437589314
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Entity Type | Organization
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Legal Business Name | SPREAD YOUR WINGS ASSISTED LIVING
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Dates
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Enumeration Date | 11/14/2013
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 2200 MARY ST
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City | HOUSTON
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State | TX
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Zip | 77026-6828
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Country | US
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Telephone | 281-864-7109
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Fax |
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Provider Business Mailing Address
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Address Line | 1123 HEATHFIELD DR
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City | CHANNELVIEW
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State | TX
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Zip | 77530-2337
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Country | US
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Telephone | 713-398-5932
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Fax |
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Authorized Official
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Title or Position | NURSING ASSISTANT
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Name | MS. JESSICA DENISE ALLS
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Credential |
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Telephone | 713-398-5932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | TX
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