Organization Name: | STADIUM EMERGENCY SHELTER |
NPI Number: | 1083969562 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RITA J. TRYON (SECRETARY) |
Mailing Address: | 21882 E Wallis Dr Porter |
State: | TX US |
Postal Code: | 773655366 |
Phone Number: | 8324361596 |
Fax Number: | |
NPI Enumeration Date: | 07/19/2012 |
NPI Last Update Date: | 07/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 385H00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Respite Care Facility |
Taxonomy Classification: | Respite Care |
Taxonomy Specialization: | |
Taxonomy Definition: |