Provider Demographics
NPI:1912619933
Name:WYSTERIA WALK INVESTMENTS LLC
Entity Type:Organization
Organization Name:WYSTERIA WALK INVESTMENTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRUPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-380-8265
Mailing Address - Street 1:14011 PARK DR STE 205
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-6289
Mailing Address - Country:US
Mailing Address - Phone:832-380-8265
Mailing Address - Fax:
Practice Address - Street 1:14011 PARK DR STE 205
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-6289
Practice Address - Country:US
Practice Address - Phone:832-380-8265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health