Provider Demographics
NPI:1578137550
Name:ACCREDITED GROUP IV LLC
Entity Type:Organization
Organization Name:ACCREDITED GROUP IV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSBACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-408-7999
Mailing Address - Street 1:21733 PROVINCIAL BLVD STE 920
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-6536
Mailing Address - Country:US
Mailing Address - Phone:832-408-7999
Mailing Address - Fax:866-708-0821
Practice Address - Street 1:21733 PROVINCIAL BLVD STE 920
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-6536
Practice Address - Country:US
Practice Address - Phone:832-408-7999
Practice Address - Fax:866-708-0821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based