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General NPI Number Information
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NPI Number | 1952738817
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Entity Type | Organization
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Legal Business Name | WESTSIDE SPIRITUAL FELLOWSHIP LLC
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Dates
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Enumeration Date | 10/08/2013
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Last Update Date | 10/08/2013
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Provider Practice Location Address
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Address Line | 16920 KUYKENDAHL RD STE 220
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City | HOUSTON
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State | TX
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Zip | 77068-1636
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Country | US
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Telephone | 281-660-7945
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Fax |
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Provider Business Mailing Address
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Address Line | 6230 W WILLOW BLUFF RD
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City | KATY
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State | TX
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Zip | 77449-8408
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Country | US
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Telephone | 281-660-7945
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Fax | 281-404-9008
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. EUSTRADA R TAYLOR SR.
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Credential |
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Telephone | 281-660-7945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | NULL
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