Healthcare Provider Details

I. General information

NPI: 1841329190
Provider Name (Legal Business Name): GREENWAY MANOR PERSONAL CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 HOPPER RD
HOUSTON TX
77093-2719
US

IV. Provider business mailing address

PO BOX 11700
HOUSTON TX
77293-1700
US

V. Phone/Fax

Practice location:
  • Phone: 281-987-3767
  • Fax: 281-987-0702
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number119109
License Number StateTX

VIII. Authorized Official

Name: MS. VIRGINIA W BAKER
Title or Position: ADMINISTRATOR
Credential: PROVIDER
Phone: 281-987-3767