Provider Demographics
NPI:1912739772
Name:SYMBOL OF CARE RESIDENTIAL SERVICES INC
Entity type:Organization
Organization Name:SYMBOL OF CARE RESIDENTIAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOMBUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-417-0932
Mailing Address - Street 1:5910 METTLER LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2239
Mailing Address - Country:US
Mailing Address - Phone:774-417-0932
Mailing Address - Fax:
Practice Address - Street 1:5910 METTLER LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-2239
Practice Address - Country:US
Practice Address - Phone:774-417-0932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization