Healthcare Provider Details

I. General information

NPI: 1164852562
Provider Name (Legal Business Name): HRA VILLAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2013
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 HIGHWAY 3 N
TEXAS CITY TX
77591-4024
US

IV. Provider business mailing address

905 HIGHWAY 3 N
TEXAS CITY TX
77591-4024
US

V. Phone/Fax

Practice location:
  • Phone: 409-935-4335
  • Fax: 409-935-4153
Mailing address:
  • Phone: 409-935-4335
  • Fax: 409-935-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number101040
License Number StateTX

VIII. Authorized Official

Name: MS. JUDY DARLENE SLOCUMB
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 409-935-4335