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General NPI Number Information
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NPI Number | 1982872883
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Entity Type | Organization
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Legal Business Name | SELOUS HEALTHCARE LLC
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 704 LONGMIRE RD SUITE 101
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City | CONROE
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State | TX
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Zip | 77304-1850
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Country | US
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Telephone | 936-441-2500
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Fax | 936-539-2515
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Provider Business Mailing Address
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Address Line | 517 COTTONWOOD CREEK RD
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City | DRIPPING SPRINGS
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State | TX
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Zip | 78620-3993
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Country | US
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Telephone |
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Fax | 866-524-7773
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Authorized Official
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Title or Position | CEO
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Name | DAVID DEGROOT
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Credential |
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Telephone | 956-878-4094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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