Provider Demographics
NPI:1407208812
Name:VICKY'S PLACE LLC
Entity Type:Organization
Organization Name:VICKY'S PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:O
Authorized Official - Last Name:HOLLIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-447-0786
Mailing Address - Street 1:21027 MORGAN KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-5139
Mailing Address - Country:US
Mailing Address - Phone:713-447-0786
Mailing Address - Fax:
Practice Address - Street 1:21027 MORGAN KNOLL LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-5139
Practice Address - Country:US
Practice Address - Phone:713-447-0786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-09
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health