Provider Demographics
NPI:1427390624
Name:STADIUM EMERGENCY SHELTER
Entity Type:Organization
Organization Name:STADIUM EMERGENCY SHELTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-354-5930
Mailing Address - Street 1:21882 E WALLIS DR
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-5366
Mailing Address - Country:US
Mailing Address - Phone:281-354-5930
Mailing Address - Fax:281-354-5935
Practice Address - Street 1:21882 E WALLIS DR
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-5366
Practice Address - Country:US
Practice Address - Phone:281-354-5930
Practice Address - Fax:281-354-5935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1442966322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children