Healthcare Provider Details

I. General information

NPI: 1114136942
Provider Name (Legal Business Name): BERING OMEGA COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 HAWTHORNE ST
HOUSTON TX
77006-3711
US

IV. Provider business mailing address

1429 HAWTHORNE ST
HOUSTON TX
77006-3711
US

V. Phone/Fax

Practice location:
  • Phone: 713-529-6071
  • Fax: 713-529-3626
Mailing address:
  • Phone: 713-529-6071
  • Fax: 713-529-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number119266
License Number StateTX

VIII. Authorized Official

Name: MRS. CHEVONNE POTTER
Title or Position: CARE CENTER MANAGER
Credential:
Phone: 713-341-3772