MEDICARE: ASSISTED LIVING CENTER OF BRAESWOOD, LLC

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

General Provider Information

NPI Number	:	1730428327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSISTED LIVING CENTER OF BRAESWOOD, LLC

Provider Business Mailing Address
First Line	:	8119 S BRAESWOOD BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-1218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8119 S BRAESWOOD BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-1218
Country	:	US
Telephone Number	:	713-776-0800
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JOSHUA OLUSEGUN OYENIYI
Credential	:
Telephone Number	:	713-776-0800

Provider Enumeration Date	:	02/03/2013
Last Update Date	:	02/03/2013

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