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General NPI Number Information
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NPI Number | 1588423263
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Entity Type | Organization
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Legal Business Name | A1 NOSTALGIC CARE INC
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Dates
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Enumeration Date | 03/15/2024
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 10426 LYRA GLEN LN
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City | RICHMOND
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State | TX
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Zip | 77406-3271
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Country | US
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Telephone | 832-418-8269
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Fax |
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Provider Business Mailing Address
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Address Line | 10426 LYRA GLEN LN
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City | RICHMOND
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State | TX
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Zip | 77406-3271
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Country | US
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Telephone | 832-418-8269
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | LILIAN T OBAYEMI
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Credential |
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Telephone | 832-418-8269
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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 | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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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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