=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093042756
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROOMES PERSONAL CARE HOME
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2009
-----------------------------------------------------
Last Update Date | 11/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6106 GRANDVALE DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77072-1516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-568-3239
-----------------------------------------------------
Fax | 281-545-2575
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6106 GRANDVALE DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77072-1516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-568-3239
-----------------------------------------------------
Fax | 281-545-2575
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. EVANGELINE ROOMES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-568-3239
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0625X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Mental Illness)
-----------------------------------------------------
License Number | 126116
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------