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General NPI Number Information
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NPI Number | 1588805162
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Entity Type | Organization
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Legal Business Name | DOWNHOMEPERSONAL CARE
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 27521 CALVERT RD
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City | TOMBALL
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State | TX
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Zip | 77377-6172
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Country | US
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Telephone | 281-351-0124
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Fax |
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Provider Business Mailing Address
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Address Line | 27521 CALVERT RD
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City | TOMBALL
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State | TX
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Zip | 77377-6172
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Country | US
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Telephone | 281-290-8542
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ELLEN LAVERN MANTLE
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Credential |
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Telephone | 281-351-0124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 12363955
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 12363955
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License Number State | TX
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