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General NPI Number Information
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NPI Number | 1568647907
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Entity Type | Organization
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Legal Business Name | WONDERFUL BLESSED CARE INC
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 06/26/2019
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Provider Practice Location Address
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Address Line | 7710 CHERRY PARK DR # 511
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City | HOUSTON
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State | TX
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Zip | 77095-2700
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Country | US
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Telephone | 281-451-8077
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Fax | 346-754-0007
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Provider Business Mailing Address
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Address Line | 5210 PEBBLE BLUFF LN
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City | SUGAR LAND
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State | TX
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Zip | 77479-3392
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Country | US
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Telephone | 281-543-7798
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Fax | 832-497-4351
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Authorized Official
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Title or Position | CEO
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Name | MR. DAVID LEWIS MILES JR.
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Credential |
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Telephone | 281-451-8077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | TX
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