Provider Demographics
NPI:1568647907
Name:WONDERFUL BLESSED CARE INC
Entity type:Organization
Organization Name:WONDERFUL BLESSED CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:MILES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:281-451-8077
Mailing Address - Street 1:5210 PEBBLE BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3392
Mailing Address - Country:US
Mailing Address - Phone:281-543-7798
Mailing Address - Fax:832-497-4351
Practice Address - Street 1:7710 CHERRY PARK DR # 511
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2700
Practice Address - Country:US
Practice Address - Phone:281-451-8077
Practice Address - Fax:346-754-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization