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General NPI Number Information
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NPI Number | 1568114817
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Entity Type | Organization
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Legal Business Name | COSMETICARE RETREAT, LLC
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 9910 CHANNEL SET WAY
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City | ROSHARON
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State | TX
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Zip | 77583-1023
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Country | US
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Telephone | 832-499-7330
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Fax |
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Provider Business Mailing Address
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Address Line | 9910 CHANNEL SET WAY
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City | ROSHARON
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State | TX
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Zip | 77583-1023
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Country | US
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Telephone | 832-499-7330
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Fax |
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Authorized Official
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Title or Position | RN, OWNER
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Name | QUANASHA SMALL
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Credential | RN,MSN
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Telephone | 832-499-7330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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