MEDICARE: ST DAVIS CORPORATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251J00000X	Nursing Care Agency
2	253Z00000X	In Home Supportive Care Agency
3	3747P1801X	Personal Care Attendant
4	251C00000X	Developmentally Disabled Services Day Training Agency
5	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1598318917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST DAVIS CORPORATION

Provider Business Mailing Address
First Line	:	5638 DARLING ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-1829
Country	:	US
Telephone Number	:	424-382-3737
Fax Number	:

Provider Business Practice Location Address
First Line	:	5638 DARLING ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-1829
Country	:	US
Telephone Number	:	424-382-3737
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. NOMSO DAVID EGWIM
Credential	:
Telephone Number	:	424-382-3737

Provider Enumeration Date	:	07/24/2019
Last Update Date	:	10/18/2024

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Directions to “ST DAVIS CORPORATION ” Practice Location

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