Healthcare Provider Details

I. General information

NPI: 1235461161
Provider Name (Legal Business Name): R. GOLDEN MEADOW PERSONAL CARE CENTEER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 TIDEWATER DR
HOUSTON TX
77045-4343
US

IV. Provider business mailing address

4411 TIDEWATER DR
HOUSTON TX
77045-4343
US

V. Phone/Fax

Practice location:
  • Phone: 713-433-8880
  • Fax:
Mailing address:
  • Phone: 713-433-8880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number125103
License Number StateTX

VIII. Authorized Official

Name: MS. AMEZE E AKHIONBARE-HARRIS
Title or Position: DIRECTOR/ADMINISTRATOR
Credential:
Phone: 713-433-8880