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General NPI Number Information
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NPI Number | 1407448426
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Entity Type | Organization
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Legal Business Name | EVERETT PLACE ASSISTED LIVING LLC
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Dates
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Enumeration Date | 02/10/2021
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 602 EVERETT ST
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City | CONROE
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State | TX
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Zip | 77301-1829
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Country | US
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Telephone | 832-949-8663
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Fax |
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Provider Business Mailing Address
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Address Line | 602 EVERETT ST
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City | CONROE
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State | TX
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Zip | 77301-1829
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Country | US
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Telephone | 832-949-8663
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | STEVEN GREEN
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Credential |
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Telephone | 832-949-8663
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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 |
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License Number State |
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