Provider Demographics
NPI:1700389962
Name:LA NUEVA CASA DE AMIGOS
Entity Type:Organization
Organization Name:LA NUEVA CASA DE AMIGOS
Other - Org Name:CITY OF HOUSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MED MPA
Authorized Official - Phone:832-393-5169
Mailing Address - Street 1:8000 N STADIUM DR
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071
Mailing Address - Country:US
Mailing Address - Phone:832-393-4288
Mailing Address - Fax:832-393-5253
Practice Address - Street 1:1809 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009
Practice Address - Country:US
Practice Address - Phone:832-395-0570
Practice Address - Fax:832-393-5253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty