=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639605207
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SERVICE TEAM INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2017
-----------------------------------------------------
Last Update Date | 05/03/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5850 SAN FELIPE ST STE 500
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77057-8003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-400-7673
-----------------------------------------------------
Fax | 713-400-7801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5850 SAN FELIPE ST STE 500
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77057-8003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-400-7673
-----------------------------------------------------
Fax | 713-400-7801
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | TIERRA WILSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 254-339-5505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------