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Organization

UPSCALE REVITALAZATION COMMUNITY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RIVERS RENARD GLOVER I (PRESIDENT)
(832) 798-6878
Entity
Organization

Contact information

Practice address
869 DULLES AVE STE D, STAFFORD, TX 77477-5754
(832) 798-6878
Mailing address
869 DULLES AVE STE D, STAFFORD, TX 77477-5754
(832) 798-6878

Taxonomy

Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary

Other

Enumeration date
06/10/2008
Last updated
06/10/2008
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