1154610053 NPI number — HOUSTON'S AMAZING PLACE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154610053 NPI number — HOUSTON'S AMAZING PLACE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOUSTON'S AMAZING PLACE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154610053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3735 DREXEL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77027-6896
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-552-0420
Provider Business Mailing Address Fax Number:
713-552-0165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3735 DREXEL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77027-6896
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-552-0420
Provider Business Practice Location Address Fax Number:
713-552-0165
Provider Enumeration Date:
03/31/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
TRACEY
Authorized Official Middle Name:
DOSS
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
713-552-0420

Provider Taxonomy Codes

  • Taxonomy code: 385H00000X , with the licence number:  126905 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)