=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528546348
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE0EIGHT SERVICES & HOLDINGS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2018
-----------------------------------------------------
Last Update Date | 08/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1008 LIVE OAK ST
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78934-2308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-848-4388
-----------------------------------------------------
Fax | 979-320-6595
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23634 DAINTREE PL
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77493-7962
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JESSICA ALEXANDER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-900-1449
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------