=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508045568
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENIOR CAREGIVERS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2007
-----------------------------------------------------
Last Update Date | 10/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 RIVER POINT DRIVE
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-756-8704
-----------------------------------------------------
Fax | 936-271-1791
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 206 A SOUTH LOOP 336 #168
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-756-8704
-----------------------------------------------------
Fax | 936-271-1791
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER-ADMINISTRATOR
-----------------------------------------------------
Name | MS. NICOLE WILSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 936-232-9144
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------