=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538936059
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSURANCE HEALTH OPTIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2023
-----------------------------------------------------
Last Update Date | 12/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2180 NORTH LOOP W STE 302A
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77018-8014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-798-1762
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2180 NORTH LOOP W STE 302A
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77018-8014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-798-1762
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/CEO
-----------------------------------------------------
Name | TIA BROWN BONDS
-----------------------------------------------------
Credential | BSW, MBA
-----------------------------------------------------
Telephone | 225-205-1820
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------