Provider Demographics
NPI:1386216612
Name:INVICTUS 1776, LLC
Entity type:Organization
Organization Name:INVICTUS 1776, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:RECORDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-954-8554
Mailing Address - Street 1:5555 SAN FELIPE ST FL 20
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-2701
Mailing Address - Country:US
Mailing Address - Phone:832-954-8554
Mailing Address - Fax:
Practice Address - Street 1:5555 SAN FELIPE ST FL 20
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-2701
Practice Address - Country:US
Practice Address - Phone:832-954-8554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty