Healthcare Provider Details

I. General information

NPI: 1699236448
Provider Name (Legal Business Name): FPACP CEDAR BAYOU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BAKER RD
BAYTOWN TX
77521-2259
US

IV. Provider business mailing address

2501 PARKVIEW DR STE 110
FORT WORTH TX
76102-5841
US

V. Phone/Fax

Practice location:
  • Phone: 281-427-9120
  • Fax: 281-427-4262
Mailing address:
  • Phone: 817-632-1000
  • Fax: 817-632-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. JAIMIE PICKETT
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 817-632-1000