=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922916931
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE LICE ANGELS OF ROCKPORT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2026
-----------------------------------------------------
Last Update Date | 08/31/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 810 HENDERSON ST STE 2
-----------------------------------------------------
City | ROCKPORT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78382-6835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-834-7891
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 810 HENDERSON ST STE 2
-----------------------------------------------------
City | ROCKPORT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78382-6835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-834-7891
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGER
-----------------------------------------------------
Name | RACHEL MILLS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 361-834-7891
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------