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General NPI Number Information
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NPI Number | 1790913416
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Entity Type | Organization
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Legal Business Name | HOUSTON EXTRAORDINARY HOME CARE II
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | 9616 BECKLEY ST
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City | HOUSTON
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State | TX
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Zip | 77088-4641
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Country | US
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Telephone | 713-298-5727
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Fax | 281-405-9764
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Provider Business Mailing Address
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Address Line | 9616 BECKLEY ST.
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City | HOUSTON
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State | TX
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Zip | 77088-4641
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Country | US
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Telephone | 713-298-5727
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Fax | 281-405-9764
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | MS. NICOLE LOUISE CARTER
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Credential | M.A.S
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Telephone | 713-298-5727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 126008
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License Number State | TX
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