=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972034858
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE PELTIER-MULCARE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2017
-----------------------------------------------------
Last Update Date | 03/23/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2307 TOMLINSON TRAIL DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77067-3797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-896-3912
-----------------------------------------------------
Fax | 832-415-2783
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | DAMASCON COURT 12507
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-428-7646
-----------------------------------------------------
Fax | 832-415-2783
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------