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General NPI Number Information
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NPI Number | 1407060262
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Entity Type | Organization
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Legal Business Name | LAKEWOOD 24 HR PERSONAL HEALTH CARE
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8416 MESA DR
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City | HOUSTON
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State | TX
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Zip | 77028-2003
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Country | US
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Telephone | 713-633-3609
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Fax | 713-631-8476
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Provider Business Mailing Address
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Address Line | PO BOX 23054
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City | HOUSTON
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State | TX
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Zip | 77228-3054
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Country | US
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Telephone | 713-633-3609
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Fax | 713-631-8476
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. CHERYL WALLER
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Credential | LPN
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Telephone | 713-633-3609
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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 | 118267
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License Number State | TX
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