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General NPI Number Information
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NPI Number | 1619283140
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Entity Type | Organization
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Legal Business Name | SPIRIT OF LIFE- PERSONAL ASSISTANCE LIVING SERVICE
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Dates
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Enumeration Date | 08/21/2010
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Last Update Date | 08/21/2010
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Provider Practice Location Address
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Address Line | 15116 LEE RD SUITE 520
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City | HUMBLE
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State | TX
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Zip | 77396-2097
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Country | US
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Telephone | 281-235-9247
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Fax |
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Provider Business Mailing Address
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Address Line | 15116 LEE RD SUITE 520
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City | HUMBLE
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State | TX
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Zip | 77396-2097
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Country | US
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Telephone | 281-235-9247
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/ WELLNESS DIRECTOR
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Name | MRS. TAWANNA CHARGOIS HARRIS
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Credential | LVN
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Telephone | 281-235-9247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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