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General NPI Number Information
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NPI Number | 1730426701
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Entity Type | Organization
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Legal Business Name | CY-FAIR MEMORY CARE, LLC
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Dates
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Enumeration Date | 01/11/2013
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Last Update Date | 01/11/2013
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Provider Practice Location Address
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Address Line | 17801 WEST RD
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City | HOUSTON
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State | TX
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Zip | 77095-5566
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Country | US
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Telephone | 281-861-2590
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Fax | 281-861-2591
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Provider Business Mailing Address
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Address Line | 545 E JOHN CARPENTER FWY SUITE 500
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City | IRVING
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State | TX
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Zip | 75062-3931
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Country | US
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Telephone | 214-845-4500
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Fax | 214-845-4501
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHAD ANDERSON
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Credential |
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Telephone | 214-845-4500
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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 | 135787
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License Number State | TX
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