=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912321829
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED HEALTH EDUCATION CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2014
-----------------------------------------------------
Last Update Date | 02/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8502 TYBOR DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77074-3012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-270-4836
-----------------------------------------------------
Fax | 713-596-9770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8502 TYBOR DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77074-3012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-270-4836
-----------------------------------------------------
Fax | 713-596-9770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MARILYN SACKETT
-----------------------------------------------------
Credential | MED, RT (R), FASRT
-----------------------------------------------------
Telephone | 713-772-0157
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------