=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720451271
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEPPING STONES TRASITIONAL LIVING AND SUPPORT SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2015
-----------------------------------------------------
Last Update Date | 11/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13610 WALTERS RD. STE A
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-928-2442
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13610 WALTERS RD.
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-858-0970
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM MANAGER
-----------------------------------------------------
Name | MRS. DEMETRIA HUNT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-858-0970
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------