Provider Demographics
NPI:1275058471
Name:STICK CHICK ENTERPRISES, LLC
Entity Type:Organization
Organization Name:STICK CHICK ENTERPRISES, LLC
Other - Org Name:YOUR DAYTIME DAUGHTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-238-0803
Mailing Address - Street 1:17630 FM 963
Mailing Address - Street 2:
Mailing Address - City:BERTRAM
Mailing Address - State:TX
Mailing Address - Zip Code:78605-3593
Mailing Address - Country:US
Mailing Address - Phone:512-238-0803
Mailing Address - Fax:
Practice Address - Street 1:17630 FM 963
Practice Address - Street 2:
Practice Address - City:BERTRAM
Practice Address - State:TX
Practice Address - Zip Code:78605-3593
Practice Address - Country:US
Practice Address - Phone:512-238-0803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STICK CHICK ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX251E00000XOtherHOME AND COMMUNITY HEALTH SERVICE