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General NPI Number Information
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NPI Number | 1942576301
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Entity Type | Organization
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Legal Business Name | GLOBAL CHAMPION'S FOR LIFE PERSONAL CARE INCORPORATED
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 03/29/2012
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Provider Practice Location Address
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Address Line | 1506 ELK RIVER ROAD
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City | HOUSTON
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State | TX
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Zip | 77090
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Country | US
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Telephone | 832-797-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 1506 ELK RIVER RD
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City | HOUSTON
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State | TX
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Zip | 77090-1144
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Country | US
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Telephone | 832-797-1600
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MRS. SCHANTEL LETICIA DUNN
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Credential |
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Telephone | 832-797-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 02762050
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License Number State | TX
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