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General NPI Number Information
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NPI Number | 1093951873
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Entity Type | Organization
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Legal Business Name | A NEW HOME FOR MOM & DAD
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Dates
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Enumeration Date | 12/27/2008
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Last Update Date | 12/27/2008
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Provider Practice Location Address
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Address Line | 600 MASON ST
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City | TOMBALL
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State | TX
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Zip | 77375-4477
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Country | US
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Telephone | 832-258-5433
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Fax | 281-516-0991
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Provider Business Mailing Address
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Address Line | 24824 STANOLIND RD
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City | TOMBALL
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State | TX
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Zip | 77375-3170
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Country | US
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Telephone | 832-258-5433
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Fax | 281-516-0991
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MARYBETH BLACKERBY
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Credential |
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Telephone | 832-258-5433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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