Healthcare Provider Details

I. General information

NPI: 1700992468
Provider Name (Legal Business Name): MICHEAL E DEBAKEY VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11623 ZARROLL DR
HOUSTON TX
77099-1558
US

IV. Provider business mailing address

11623 ZARROLL DR
HOUSTON TX
77099-1558
US

V. Phone/Fax

Practice location:
  • Phone: 713-791-1414
  • Fax:
Mailing address:
  • Phone: 713-791-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. HOMER FAWCETT ESPILOY
Title or Position: NURSING ASSISTANT
Credential:
Phone: 713-791-1414