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General NPI Number Information
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NPI Number | 1558572156
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Entity Type | Organization
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Legal Business Name | DIVINE ASSISTED CENTER
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 15502 EMPANADA DR
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City | HOUSTON
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State | TX
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Zip | 77083-4112
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Country | US
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Telephone | 832-788-0387
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Fax |
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Provider Business Mailing Address
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Address Line | 15502 EMPANADA DR
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City | HOUSTON
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State | TX
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Zip | 77083-4112
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Country | US
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Telephone | 832-788-0387
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | KATE IGBOWKE
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Credential |
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Telephone | 832-788-0387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number | 120466
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License Number State | TX
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