KELLY TAYLOR-VERVALIN (NPI# 1629420047) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629420047 |
| Entity Type | Individual |
| Full Name | KELLY TAYLOR-VERVALIN |
| Credential | LCDC-I |
| Practice Address |
1820 County Road 36 Angleton TX 77515-8727 |
| Mailing Address |
14002 Towne Way Dr Sugar Land TX 77498-1570 |
| Practice Telephone | 8328772121 |
| Mailing Telephone | 8328772121 |
| Enumeration Date | 2016-07-09 |
| Last Update Date | 2016-07-09 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 17430 | TX | Residential Treatment Facilities |
| Street Address |
1820 COUNTY ROAD 36 |
| City | ANGLETON |
| State | TX |
| Zip Code | 77515-8727 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356620314 | Monica Rose Mehalshick | Contractor | 1820 County Road 36, Serenity Light Recovery LLC, Angleton, TX 77515 | 2011-08-09 |
| 1962958280 | William Matthew Buckmaster | Counselor | 1820 County Road 36, Angleton, TX 77515-8727 | 2016-08-28 |
| 1376096461 | Rita L Pruitt | Counselor | 1820 County Road 36, Angleton, TX 77515-8727 | 2016-07-26 |
| 1972954956 | Kristina Barrett | Counselor | 1820 County Road 36, Angleton, TX 77515-8727 | 2016-06-30 |
| 1457736340 | Serenity Light Recovery LLC | Substance Abuse Rehabilitation Facility | 1820 County Road 36, Angleton, TX 77515-8727 | 2015-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932725561 | Eve Salinas | Registered Nurse | 610 Cr 199 #11, Angelon, TX 77515 | 2020-06-19 |
| 1861953754 | Ez Pharmacy Group LLC | Pharmacy | 1100 C E Mulberry, Angelton, TX 77515 | 2019-03-25 |
| 1063910230 | Servicios Medicos Para Todos S.a. De C.v. | General Acute Care Hospital | 872-874 Av. Lopez Portillo Sm 59 Mz 37, Unidad Morelos Entre Av. Kabah Y Av. Comalcalco, Cancun, QUINTANA ROO 77515 | 2018-01-23 |
| 1922536671 | Covenant Mobile Healthcare LLC | Nurse Practitioner | Family First Primary Care, 732 E. Henderson Rd, Angleton, TX 77515 | 2017-05-25 |
| 1992254726 | Stephen Ricks Jr. | Nurse Practitioner | 732 E. Henderson Rd, Angleton, TX 77515 | 2016-09-21 |
| 1568849867 | Nancy Vanaphan | Physician Assistant | 146 E Hospital Dr Ste 208, Angleton, TX 77515 | 2015-05-06 |
| 1235560723 | Neuro Analysis Diagnostics | Clinic/Center | 2315 E. Magnolia St., Angleton, TX 77515 | 2013-12-09 |
| 1619308327 | Patricia G. Rios | Speech-Language Pathologist | 120 E. Hospital Dr., Angleton, TX 77515 | 2013-12-05 |
| 1336587716 | Educare Community Living Corporation - Texas | Intermediate Care Facility, Mentally Retarded | 800 N. Arcola, Angelton, TX 77515 | 2013-06-07 |
| 1376872135 | Classic Care Adult Day Care | Day Training, Developmentally Disabled Services | 509 N Downing Ste. B, Angleton, TX 77515 | 2009-12-08 |
| Find all providers in zip 77515 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457736340 | Serenity Light Recovery LLC | Substance Abuse Rehabilitation Facility | 1820 County Road 36, Angleton, TX 77515-8727 | 2015-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801496302 | Sunrise Rehab and Recovery, LLC | Substance Abuse Rehabilitation Facility | 1106 N Interstate 35, San Marcos, TX 78666-7030 | 2020-10-26 |
| 1124627443 | Resurgence Texas | Substance Abuse Rehabilitation Facility | 10703 Ranch Road 12, Wimberley, TX 78676-5239 | 2020-10-19 |
| 1053918151 | The Salvation Army, A Georgia Corp. - Mabee Center | Substance Abuse Rehabilitation Facility | 1855 E. Lancaster Ave., Fort Worth, TX 76103-2123 | 2020-10-02 |
| 1174139364 | Voice To Discovery Community | Substance Abuse Rehabilitation Facility | 7811 Hornwood Dr, Houston, TX 77036-4115 | 2020-09-22 |
| 1093329484 | Alara Health | Substance Abuse Rehabilitation Facility | 4731 County Road 172, Alvin, TX 77511-0325 | 2020-09-02 |
| 1659982437 | Oliver-west Health and Wellness Center | Substance Abuse Rehabilitation Facility | 9009 Boone Rd Ste A, Houston, TX 77099-2033 | 2020-08-13 |
| 1730798893 | Starlite Recovery Center, LLC | Substance Abuse Rehabilitation Facility | 2210 Bandera Hwy Ste C-1, Kerrville, TX 78028-6609 | 2020-07-24 |
| 1043837644 | Alaine Detox Center LLC | Substance Abuse Rehabilitation Facility | 3505 Sage Rd Unit 2504, Houston, TX 77056-7183 | 2020-06-30 |
| 1821614181 | Lighthouse Recovery Centers, LLC | Substance Abuse Rehabilitation Facility | 5344 Alpha Rd, Dallas, TX 75240-3428 | 2020-06-23 |
| 1306460266 | Revive F W | Substance Abuse Rehabilitation Facility | 10907 Martindale Rd, Houston, TX 77048-2011 | 2020-06-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.