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General NPI Number Information
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NPI Number | 1730522459
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Entity Type | Organization
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Legal Business Name | ERICA COCO EMBOLA
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Dates
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Enumeration Date | 04/11/2013
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 12401 OVERBROOK LN 61D
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City | HOUSTON
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State | TX
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Zip | 77077-5859
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Country | US
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Telephone | 361-549-2954
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Fax |
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Provider Business Mailing Address
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Address Line | 12401 OVERBROOK LN 61D
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City | HOUSTON
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State | TX
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Zip | 77077-5859
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Country | US
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Telephone | 361-549-2954
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | ERICA COCO EMBOLA
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Credential |
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Telephone | 361-549-2954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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