Healthcare Provider Details

I. General information

NPI: 1154319713
Provider Name (Legal Business Name): SENIORLIVINGSPROPERTIESLAPORTEHEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 S UTAH ST
LA PORTE TX
77571-5555
US

IV. Provider business mailing address

208 S UTAH ST
LA PORTE TX
77571-5555
US

V. Phone/Fax

Practice location:
  • Phone: 281-471-1810
  • Fax: 281-471-8809
Mailing address:
  • Phone: 281-471-1810
  • Fax: 281-471-8809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BARBARA CARROLL
Title or Position: ADMINISTRATOR
Credential:
Phone: 281-471-1810