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13806 Sandstone Bridge Ln Rosharon TX 77583-1612 | |
| (901) 550-9585 | |
| (901) 791-4390 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 13806 Sandstone Bridge Ln, Rosharon, Texas |
| Authorized Official Name and Position | Nicholas Hardy (OWNER) |
| Authorized Official Contact | 9015509585 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
13806 Sandstone Bridge Ln Rosharon TX 77583-1612 Ph: (901) 550-9585 | 13806 Sandstone Bridge Ln Rosharon TX 77583-1612 Ph: (901) 550-9585 |
| NPI Number | 1144066846 |
|---|---|
| Provider Enumeration Date | 07/02/2024 |
| Last Update Date | 08/13/2024 |
| Certification Date | 08/13/2024 |
| Medicare PECOS PAC ID | 7012454341 |
|---|---|
| Medicare Enrollment ID | O20240805003237 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144066846 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Nicholas Hardy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194028662 PECOS PAC ID: 8921545252 Enrollment ID: I20240805003443 |
| Provider Name | Belinda Hardy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437186145 PECOS PAC ID: 4880508084 Enrollment ID: I20240816001510 |
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