MEDICARE: JOSHUAS PLACE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA2000X	Administrator Registered Nurse	681192	TX

General Provider Information

NPI Number	:	1043293301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSHUAS PLACE LLC

Provider Business Mailing Address
First Line	:	PO BOX 20325
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77225-0325
Country	:	US
Telephone Number	:	832-778-1655
Fax Number	:	832-778-1657

Provider Business Practice Location Address
First Line	:	2656 SOUTH LOOP W
Second Line	:	SUITE 233
City	:	HOUSTON
State	:	TX
Zip	:	77054-2664
Country	:	US
Telephone Number	:	832-778-1655
Fax Number	:	832-778-1657

Authorized Official
Title or Position	:	OWNER & ADMINISTRATOR
Name	:	MRS. MONIQUE ELIZABETH TAYLOR
Credential	:	MS MBA
Telephone Number	:	832-778-1655

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	08/22/2020

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Directions to “JOSHUAS PLACE LLC ” Practice Location

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