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General NPI Number Information
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NPI Number | 1548032303
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Entity Type | Organization
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Legal Business Name | RODRICK'S PLACE LLC
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 7731 GLENLEA ST
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City | HOUSTON
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State | TX
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Zip | 77061-2111
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Country | US
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Telephone | 713-820-7097
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 BALCONES DR # 15814
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City | AUSTIN
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State | TX
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Zip | 78731-4257
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Country | US
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Telephone | 713-820-7097
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SOPHRONIA GAY BOURGEOIS
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Credential |
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Telephone | 713-820-7097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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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 | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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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 | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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