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General NPI Number Information
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NPI Number | 1861752743
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Entity Type | Organization
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Legal Business Name | SUGARLAND EXTRA MILE HOME HEALTHCARE SERVICES, INC.
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Dates
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Enumeration Date | 05/24/2012
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 9435 EAGLEWOOD SPRING DR
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City | HOUSTON
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State | TX
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Zip | 77083-5130
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Country | US
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Telephone | 281-980-0078
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Fax | 281-980-0846
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Provider Business Mailing Address
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Address Line | 9435 EAGLEWOOD SPRING DR
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City | HOUSTON
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State | TX
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Zip | 77083-5130
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Country | US
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Telephone | 281-980-0078
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Fax | 281-980-0846
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. GUSTAVUS AINA SPAINE
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Credential | RN
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Telephone | 713-516-7841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 14803
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License Number State | TX
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