Provider Demographics
NPI:1952738817
Name:WESTSIDE SPIRITUAL FELLOWSHIP LLC
Entity Type:Organization
Organization Name:WESTSIDE SPIRITUAL FELLOWSHIP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EUSTRADA
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:281-660-7945
Mailing Address - Street 1:6230 W WILLOW BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-8408
Mailing Address - Country:US
Mailing Address - Phone:281-660-7945
Mailing Address - Fax:281-404-9008
Practice Address - Street 1:16920 KUYKENDAHL RD STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-1636
Practice Address - Country:US
Practice Address - Phone:281-660-7945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care