=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740603851
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSIST SENIORS FELLOWSHIP - THF
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2014
-----------------------------------------------------
Last Update Date | 01/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7114 STILL HAVEN DR
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77407-7129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-473-7169
-----------------------------------------------------
Fax | 320-382-7766
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7114 STILL HAVEN DR
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77407-7129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-473-7169
-----------------------------------------------------
Fax | 320-382-7766
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KENNETH EARL RUSHING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-473-7169
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------