MEDICARE: BEDFORD RESIDENCE AND HEALTH CARE SERVICES

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	010301	TX

General Provider Information

NPI Number	:	1558675413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEDFORD RESIDENCE AND HEALTH CARE SERVICES

Provider Business Mailing Address
First Line	:	11718 BEDFORD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-2112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11718 BEDFORD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-2112
Country	:	US
Telephone Number	:	281-498-3301
Fax Number	:	281-575-7874

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DELIA M. AGUSTIN
Credential	:	RN
Telephone Number	:	281-498-3301

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	08/03/2010

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