Provider Demographics
NPI:1124338603
Name:GD MILESTONE COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:GD MILESTONE COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANAVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-444-1191
Mailing Address - Street 1:PO BOX 941836
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094
Mailing Address - Country:US
Mailing Address - Phone:281-444-1191
Mailing Address - Fax:281-444-1194
Practice Address - Street 1:6903 RED OAK
Practice Address - Street 2:272
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090
Practice Address - Country:US
Practice Address - Phone:281-444-1191
Practice Address - Fax:281-444-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty