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General NPI Number Information
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NPI Number | 1912484478
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Entity Type | Organization
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Legal Business Name | GROVER-JACKSON INDUSTRIES, LLC
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Dates
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Enumeration Date | 07/26/2018
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Last Update Date | 07/26/2018
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Provider Practice Location Address
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Address Line | 1906 QUAIL GREEN CT
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City | MISSOURI CITY
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State | TX
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Zip | 77489-3041
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Country | US
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Telephone | 713-320-7289
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 464
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City | STAFFORD
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State | TX
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Zip | 77497-0464
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Country | US
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Telephone | 713-320-7289
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | KANDRA S. GROVER
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Credential |
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Telephone | 713-320-7289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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