MEDICARE: TEXAS CITY ASSISTED LIVING, LTD.

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	124610	TX

General Provider Information

NPI Number	:	1831337039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS CITY ASSISTED LIVING, LTD.

Provider Business Mailing Address
First Line	:	1901 N AMBURN RD
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-2488
Country	:	US
Telephone Number	:	409-935-6620
Fax Number	:	409-933-0658

Provider Business Practice Location Address
First Line	:	1901 N AMBURN RD
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-2488
Country	:	US
Telephone Number	:	409-935-6620
Fax Number	:	409-933-0658

Authorized Official
Title or Position	:	VICE PRESIDENT/CONTROLLER
Name	:	LIZ VARGAS
Credential	:
Telephone Number	:	281-362-3506

Provider Enumeration Date	:	01/26/2009
Last Update Date	:	01/26/2009

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