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General NPI Number Information
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NPI Number | 1841329190
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Entity Type | Organization
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Legal Business Name | GREENWAY MANOR PERSONAL CARE HOME
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3625 HOPPER RD
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City | HOUSTON
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State | TX
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Zip | 77093-2719
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Country | US
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Telephone | 281-987-3767
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Fax | 281-987-0702
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Provider Business Mailing Address
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Address Line | PO BOX 11700
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City | HOUSTON
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State | TX
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Zip | 77293-1700
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. VIRGINIA W BAKER
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Credential | PROVIDER
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Telephone | 281-987-3767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 119109
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License Number State | TX
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