Provider Demographics
NPI:1750710075
Name:FILLING THE GAP ADULT DAY CARE LLC
Entity type:Organization
Organization Name:FILLING THE GAP ADULT DAY CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-286-1242
Mailing Address - Street 1:6734 ANTOINE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091
Mailing Address - Country:US
Mailing Address - Phone:281-741-0102
Mailing Address - Fax:281-783-2442
Practice Address - Street 1:6734 ANTOINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091
Practice Address - Country:US
Practice Address - Phone:281-741-0102
Practice Address - Fax:281-783-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care