=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871899153
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BY YOUR SIDE HEALTHCARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2011
-----------------------------------------------------
Last Update Date | 02/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1222 CANTERVIEW DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77047-3211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-650-6891
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1222 CANTERVIEW DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77047-3211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-650-6891
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CNA
-----------------------------------------------------
Name | MR. WILLIAM ANTIONE SINGLETON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-650-6891
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number | NA08127461
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | NA08127461
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 315D00000X
-----------------------------------------------------
Taxonomy Name | Inpatient Hospice
-----------------------------------------------------
License Number | NA08127461
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | NA08127461
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------