Healthcare Provider Details

I. General information

NPI: 1891936472
Provider Name (Legal Business Name): BRAEBURN VALLEY PERSONAL CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8215 BRAESVIEW LN
HOUSTON TX
77071-1229
US

IV. Provider business mailing address

8215 BRAESVIEW LN
HOUSTON TX
77071-1229
US

V. Phone/Fax

Practice location:
  • Phone: 832-433-7311
  • Fax: 832-433-7311
Mailing address:
  • Phone: 832-433-7311
  • Fax: 832-433-7311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. GLORIA JEAN CLANTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 832-433-7311