Healthcare Provider Details

I. General information

NPI: 1154357218
Provider Name (Legal Business Name): MEMORIAL SENIOR SERVICES NURSING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 BEECHNUT
HOUSTON TX
77074
US

IV. Provider business mailing address

PO BOX 201367
HOUSTON TX
77216-1367
US

V. Phone/Fax

Practice location:
  • Phone: 713-456-5000
  • Fax: 713-338-4158
Mailing address:
  • Phone: 713-338-4127
  • Fax: 713-338-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number000407
License Number StateTX

VIII. Authorized Official

Name: MR. DENNIS LARAWAY
Title or Position: CFO
Credential:
Phone: 713-242-2707