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General NPI Number Information
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NPI Number | 1700918992
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Entity Type | Organization
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Legal Business Name | GROUNDSWELL, LLC
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 05/11/2020
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Provider Practice Location Address
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Address Line | 28314 CALVERT RD
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City | TOMBALL
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State | TX
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Zip | 77377-6167
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Country | US
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Telephone | 281-351-8585
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Fax | 281-255-4757
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Provider Business Mailing Address
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Address Line | 28314 CALVERT RD
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City | TOMBALL
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State | TX
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Zip | 77377-6167
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Country | US
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Telephone | 281-351-8585
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Fax | 281-255-4757
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Authorized Official
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Title or Position | PROGRAM SPONSOR/DIRECTOR
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Name | JOBETH RICKARD
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Credential |
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Telephone | 281-351-8585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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