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General NPI Number Information
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NPI Number | 1467037457
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Entity Type | Organization
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Legal Business Name | XENNIAL SENIOR CARE SERVICES LLC
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Dates
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Enumeration Date | 03/11/2021
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 945 SGT ED HOLCOMB BLVD S STE 20
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City | CONROE
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State | TX
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Zip | 77304-1130
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Country | US
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Telephone | 936-703-8394
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Fax |
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Provider Business Mailing Address
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Address Line | 482 WOODPECKER FOREST LN
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City | CONROE
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State | TX
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Zip | 77384-3757
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Country | US
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Telephone | 651-398-9925
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Fax |
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Authorized Official
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Title or Position | OWNER/ALTERNATE ADMINISTRATOR
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Name | TRISTA JOHNSON
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Credential |
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Telephone | 651-398-9925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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