Healthcare Provider Details

I. General information

NPI: 1831448778
Provider Name (Legal Business Name): HSRE-BRIDGEWOOD TRS II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 N. BRAESWOOD BLVD.
HOUSTON TX
77005
US

IV. Provider business mailing address

1502 AUGUSTA DRIVE, SUITE 380
HOUSTON TX
77057
US

V. Phone/Fax

Practice location:
  • Phone: 713-665-4141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES GRAY
Title or Position: PRESIDENT
Credential:
Phone: 713-623-6767