Organization
RISING STAR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUNDREA ANDERSON (GENERAL MANAGER)
(228) 224-5840
Entity
Organization
Contact information
Practice address
434 DIANA DR, CONVERSE, TX 78109-1136
(850) 428-6527
Mailing address
434 DIANA DR, CONVERSE, TX 78109-1136
(850) 428-6527
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
—
—
Other
Enumeration date
07/30/2014
Last updated
07/30/2014
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