Provider Demographics
NPI:1003206202
Name:COMMUNITY PRESCRIBED PEDIATRIC EXTENDED DAY CARE INC
Entity Type:Organization
Organization Name:COMMUNITY PRESCRIBED PEDIATRIC EXTENDED DAY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINITRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLOTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALATAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-565-1733
Mailing Address - Street 1:5610 AVIS HILL CT
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441
Mailing Address - Country:US
Mailing Address - Phone:281-565-1733
Mailing Address - Fax:
Practice Address - Street 1:2918 N RICHMOND RD
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-2006
Practice Address - Country:US
Practice Address - Phone:281-565-1733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric