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General NPI Number Information
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NPI Number | 1649589045
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Entity Type | Organization
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Legal Business Name | PHENOMENAL LIVING INC
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Dates
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Enumeration Date | 10/02/2010
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Last Update Date | 10/02/2010
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Provider Practice Location Address
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Address Line | 21910 CATOOSA DR
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City | SPRING
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State | TX
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Zip | 77388-6902
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Country | US
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Telephone | 281-846-8273
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Fax | 832-813-8569
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Provider Business Mailing Address
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Address Line | 21910 CATOOSA DR
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City | SPRING
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State | TX
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Zip | 77388-6902
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Country | US
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Telephone | 281-846-8273
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Fax | 832-813-8569
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Authorized Official
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Title or Position | CEO
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Name | MRS. KIVIETTE NORSHENIA PHARR
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Credential |
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Telephone | 281-846-8273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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