Healthcare Provider Details

I. General information

NPI: 1245852391
Provider Name (Legal Business Name): THE PARK AT BAY AREA LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 SPACE CENTER BLVD
PASADENA TX
77505-3966
US

IV. Provider business mailing address

5000 SPACE CENTER BLVD
PASADENA TX
77505-3966
US

V. Phone/Fax

Practice location:
  • Phone: 281-721-2500
  • Fax:
Mailing address:
  • Phone: 281-721-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: DARCY WHATLEY
Title or Position: PRESIDENT
Credential:
Phone: 281-339-7340