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General NPI Number Information
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NPI Number | 1770039166
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Entity Type | Organization
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Legal Business Name | SUPREME MEMORY CARE LLC
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Dates
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Enumeration Date | 08/26/2016
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Last Update Date | 08/26/2016
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Provider Practice Location Address
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Address Line | 11750 PADON RD
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City | NEEDVILLE
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State | TX
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Zip | 77461-9681
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Country | US
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Telephone | 832-282-7363
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Fax |
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Provider Business Mailing Address
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Address Line | 11750 PADON RD
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City | NEEDVILLE
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State | TX
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Zip | 77461-9681
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Country | US
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Telephone | 832-282-7363
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ELIZABETH WILLIAMS
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Credential |
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Telephone | 832-282-7363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 106501
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License Number State | TX
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