Healthcare Provider Details

I. General information

NPI: 1083846497
Provider Name (Legal Business Name): COMPASSIONATE CARE SENIOR LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 JEB STUART LN
CONROE TX
77302-3813
US

IV. Provider business mailing address

555 STEPHEN F AUSTIN DR
CONROE TX
77302-1204
US

V. Phone/Fax

Practice location:
  • Phone: 936-271-3263
  • Fax: 936-271-9413
Mailing address:
  • Phone: 936-232-9144
  • Fax: 936-271-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. NICOLE WILSON
Title or Position: OWNER/OPERATOR
Credential:
Phone: 936-232-9144