Healthcare Provider Details

I. General information

NPI: 1386644201
Provider Name (Legal Business Name): HAPPY HARBOR METHODIST HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 BAYSHORE DR
LA PORTE TX
77571-5868
US

IV. Provider business mailing address

1106 BAYSHORE DR
LA PORTE TX
77571-5868
US

V. Phone/Fax

Practice location:
  • Phone: 281-471-1210
  • Fax: 281-867-9065
Mailing address:
  • Phone: 281-471-1210
  • Fax: 281-867-9065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number109624
License Number StateTX

VIII. Authorized Official

Name: MR. RICHARD M BERMAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 281-363-2600