Healthcare Provider Details

I. General information

NPI: 1538398565
Provider Name (Legal Business Name): SUNNY LIVING RESIDENTIAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2009
Last Update Date: 10/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3154 JORNS ST
HOUSTON TX
77045-4619
US

IV. Provider business mailing address

3154 JORNS ST
HOUSTON TX
77045-4619
US

V. Phone/Fax

Practice location:
  • Phone: 832-794-0495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. STANLEY B MATTHEWS
Title or Position: ADMINISTRATOR
Credential:
Phone: 832-794-0495