Provider Demographics
NPI:1699071985
Name:SPEEDYCARE LLC
Entity type:Organization
Organization Name:SPEEDYCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:281-785-0038
Mailing Address - Street 1:100 INTERSTATE 45 N STE 124
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-2701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8765 SPRING CYPRESS RD
Practice Address - Street 2:SUITE L BOX 154
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-1900
Practice Address - Country:US
Practice Address - Phone:281-785-0038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX195611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty