Provider Demographics
NPI:1013247634
Name:MONROVIA ROCK
Entity Type:Organization
Organization Name:MONROVIA ROCK
Other - Org Name:UNIQUE MEMORIES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:EBENEZER
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:281-879-9100
Mailing Address - Street 1:14165 BISSONNET ST
Mailing Address - Street 2:SUITE NUMBER P
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-6356
Mailing Address - Country:US
Mailing Address - Phone:281-879-9100
Mailing Address - Fax:281-879-9102
Practice Address - Street 1:14165 BISSONNET ST
Practice Address - Street 2:SUITE NUMBER P
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-6356
Practice Address - Country:US
Practice Address - Phone:281-879-9100
Practice Address - Fax:281-879-9102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIQUE MEMORIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171M00000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty