MEDICARE: LADYBIRDS SENIOR CARE HOME LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	310400000X	Assisted Living Facility
2	311500000X	Alzheimer Center (Dementia Center)
3	343900000X	Non-emergency Medical Transport (VAN)
4	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1255873907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LADYBIRDS SENIOR CARE HOME LLC

Provider Business Mailing Address
First Line	:	5827 KNOLLWOOD TRL
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-4986
Country	:	US
Telephone Number	:	713-269-9235
Fax Number	:	866-423-3747

Provider Business Practice Location Address
First Line	:	4810 AQUAGATE DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-4943
Country	:	US
Telephone Number	:	713-269-9235
Fax Number	:	866-423-3747

Authorized Official
Title or Position	:	CEO
Name	:	CHRISTINA SIMMONS
Credential	:
Telephone Number	:	281-407-0605

Provider Enumeration Date	:	11/11/2016
Last Update Date	:	07/20/2024

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