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General NPI Number Information
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NPI Number | 1083054365
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Entity Type | Organization
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Legal Business Name | SIX PALMS AT DAMOOR ESTATES, LLC
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Dates
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Enumeration Date | 07/01/2013
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Last Update Date | 07/01/2013
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Provider Practice Location Address
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Address Line | 5815 AVENUE A
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City | ROSHARON
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State | TX
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Zip | 77583-7107
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Country | US
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Telephone | 281-543-9458
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Fax |
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Provider Business Mailing Address
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Address Line | 5409 CROIX RD
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City | MANVEL
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State | TX
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Zip | 77578-2722
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JACKIE L. MOORE
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Credential |
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Telephone | 281-543-9458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 136883
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License Number State | TX
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