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General NPI Number Information
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NPI Number | 1578137550
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Entity Type | Organization
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Legal Business Name | ACCREDITED GROUP IV LLC
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Dates
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Enumeration Date | 05/14/2021
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Last Update Date | 05/14/2021
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Provider Practice Location Address
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Address Line | 21733 PROVINCIAL BLVD STE 920
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City | KATY
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State | TX
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Zip | 77450-6536
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Country | US
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Telephone | 832-408-7999
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Fax | 866-708-0821
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Provider Business Mailing Address
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Address Line | 21733 PROVINCIAL BLVD STE 920
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City | KATY
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State | TX
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Zip | 77450-6536
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Country | US
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Telephone | 832-408-7999
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Fax | 866-708-0821
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JERRY MOSBACHER
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Credential |
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Telephone | 832-408-7999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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