Healthcare Provider Details

I. General information

NPI: 1609355700
Provider Name (Legal Business Name): PROVIDENCE ASSISTED LIVING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8202 ASH GARDEN CT
HOUSTON TX
77083-6518
US

IV. Provider business mailing address

8202 ASH GARDEN CT
HOUSTON TX
77083-6518
US

V. Phone/Fax

Practice location:
  • Phone: 281-980-2977
  • Fax: 281-242-2265
Mailing address:
  • Phone: 281-980-2977
  • Fax: 281-242-2265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MONICA IGWE
Title or Position: PRESIDENT
Credential:
Phone: 281-980-2977