MEDICARE: PEACE OF MIND ADULT DAY CARE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305S00000X	Point of Service

General Provider Information

NPI Number	:	1134673072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACE OF MIND ADULT DAY CARE CENTER

Provider Business Mailing Address
First Line	:	3355 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3605
Country	:	US
Telephone Number	:	281-537-1966
Fax Number	:

Provider Business Practice Location Address
First Line	:	3355 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3605
Country	:	US
Telephone Number	:	281-537-1966
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DEBRA JOHNSON
Credential	:
Telephone Number	:	713-992-6490

Provider Enumeration Date	:	08/09/2016
Last Update Date	:	08/09/2016

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