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General NPI Number Information
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NPI Number | 1881826212
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Entity Type | Organization
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Legal Business Name | NURTURING HAVEN ADULT DAY CENTER INC.
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Dates
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Enumeration Date | 08/18/2009
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Last Update Date | 08/18/2009
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Provider Practice Location Address
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Address Line | 400 S MAIN ST
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City | JASPER
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State | TX
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Zip | 75951-4514
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Country | US
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Telephone | 409-384-6347
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Fax |
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Provider Business Mailing Address
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Address Line | 113 CRUSE ST P O BOX 421
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City | JASPER
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State | TX
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Zip | 75951-2341
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Country | US
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Telephone | 409-384-6347
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Fax |
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Authorized Official
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Title or Position | LVN
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Name | MRS. JO ANN SCOTT
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Credential |
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Telephone | 409-384-6347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 158577
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License Number State | TX
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