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General NPI Number Information
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NPI Number | 1972050946
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Entity Type | Organization
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Legal Business Name | FUTURISTIKIDZ RESIDENTIAL FACILITY
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 683 FM 980RD.
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City | HUNTSVILLE
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State | TX
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Zip | 77320
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Country | US
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Telephone | 888-832-7259
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Fax |
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Provider Business Mailing Address
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Address Line | 683 FM 980 RD
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City | HUNTSVILLE
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State | TX
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Zip | 77320-7406
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Country | US
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Telephone | 832-888-7259
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT STUARD
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Credential | LCDC
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Telephone | 832-888-7259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | TX
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