=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851854400
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAIL MARY CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2019
-----------------------------------------------------
Last Update Date | 04/10/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1005 CANDLELIGHT LN
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77018-2003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-620-7564
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11111 KATY FWY STE 910
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77079-2119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-620-7564
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CARE MANAGER
-----------------------------------------------------
Name | MS. SONIA HARRISON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-620-7564
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------