Provider Demographics
NPI:1366818130
Name:SHF SUGARLAND MY WELLNESS PLACE
Entity Type:Organization
Organization Name:SHF SUGARLAND MY WELLNESS PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-778-1300
Mailing Address - Street 1:6200 SAVOY DR
Mailing Address - Street 2:SUITE 540
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3300
Mailing Address - Country:US
Mailing Address - Phone:713-778-1300
Mailing Address - Fax:713-778-0827
Practice Address - Street 1:13020 DAIRY ASHFORD RD
Practice Address - Street 2:SUITE#100
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3151
Practice Address - Country:US
Practice Address - Phone:281-277-8571
Practice Address - Fax:281-277-8564
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. HOPE FOUNDATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00791XMedicare PIN