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General NPI Number Information
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NPI Number | 1477109536
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Entity Type | Organization
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Legal Business Name | SACRED SENIORS
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 144 WOOD FARM RD
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City | HUNTSVILLE
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State | TX
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Zip | 77320-1742
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Country | US
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Telephone | 936-439-6033
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Fax | 936-439-6033
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Provider Business Mailing Address
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Address Line | 144 WOOD FARM RD
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City | HUNTSVILLE
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State | TX
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Zip | 77320-1742
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Country | US
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Telephone | 936-439-6033
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Fax | 936-439-6033
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. MICHELLE LEWIS
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Credential | MSW
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Telephone | 936-439-6033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | 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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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