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General NPI Number Information
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NPI Number | 1629447172
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Entity Type | Organization
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Legal Business Name | FISHER HAVEN ASSISTED LIVING CENTER
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 2440 TEXAS PKWY STE 140
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City | MISSOURI CITY
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State | TX
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Zip | 77489-4207
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Country | US
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Telephone | 832-668-0860
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Fax | 281-969-7587
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Provider Business Mailing Address
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Address Line | 2440 TEXAS PKWY STE 140
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City | MISSOURI CITY
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State | TX
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Zip | 77489-4207
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Country | US
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Telephone | 832-668-0860
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Fax | 281-969-7587
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Authorized Official
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Title or Position | OWNER
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Name | MS. DORETTA PERRO FISHER
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Credential |
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Telephone | 83266800860
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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 | 102554
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License Number State | TX
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