MEDICARE: HOME SWEET HOME RESIDENTIAL CARE FACIULITY FOR THE ELDERLY

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	310400000X	Assisted Living Facility	143306	TX

General Provider Information

NPI Number	:	1437486545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME SWEET HOME RESIDENTIAL CARE FACIULITY FOR THE ELDERLY

Provider Business Mailing Address
First Line	:	PO BOX 983
Second Line	:
City	:	FULSHEAR
State	:	TX
Zip	:	77441-0983
Country	:	US
Telephone Number	:	281-704-1164
Fax Number	:

Provider Business Practice Location Address
First Line	:	12142 7TH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-5322
Country	:	US
Telephone Number	:	281-704-1164
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ROLANDO S. VELASQUEZ
Credential	:
Telephone Number	:	281-704-1164

Provider Enumeration Date	:	11/10/2009
Last Update Date	:	10/25/2016

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