Healthcare Provider Details

I. General information

NPI: 1053534248
Provider Name (Legal Business Name): SENIOR CITIZENS OF SAN JACINTO COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date: 06/03/2008
Reactivation Date: 08/14/2008

III. Provider practice location address

60 BUTLER STREET
COLDSPRING TX
77331
US

IV. Provider business mailing address

PO BOX 145 SENIOR CITIZENS CENTER
COLDSPRING TX
77331
US

V. Phone/Fax

Practice location:
  • Phone: 936-653-4175
  • Fax: 936-653-3412
Mailing address:
  • Phone: 936-653-4175
  • Fax: 936-653-3412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROLYN KAY SHIPP
Title or Position: ADMINISTRATOR
Credential:
Phone: 936-653-4175