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General NPI Number Information
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NPI Number | 1932364973
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Entity Type | Organization
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Legal Business Name | HARVEST HOME, INC.
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Dates
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Enumeration Date | 07/18/2008
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Last Update Date | 07/18/2008
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Provider Practice Location Address
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Address Line | 520 BAKER DR
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City | TOMBALL
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State | TX
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Zip | 77375-4121
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Country | US
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Telephone | 281-357-5775
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Fax |
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Provider Business Mailing Address
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Address Line | 520 BAKER DR
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City | TOMBALL
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State | TX
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Zip | 77375-4121
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Country | US
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Telephone | 281-357-5775
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JIMMY CLYDE SHAW
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Credential |
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Telephone | 281-703-7711
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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 | 0392
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License Number State | TX
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