Healthcare Provider Details

I. General information

NPI: 1114129582
Provider Name (Legal Business Name): ALDINE COMMUNITY CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10110 AIRLINE DR
HOUSTON TX
77037-1406
US

IV. Provider business mailing address

10110 AIRLINE DR
HOUSTON TX
77037-1406
US

V. Phone/Fax

Practice location:
  • Phone: 281-820-5226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number101964
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number101963
License Number StateTX

VIII. Authorized Official

Name: JESSE DUNN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 281-820-5226