MEDICARE: PEARLAND MEMORY CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	104926	TX

General Provider Information

NPI Number	:	1073887196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARLAND MEMORY CARE, LLC

Provider Business Mailing Address
First Line	:	545 E JOHN CARPENTER FWY
Second Line	:	SUITE 500
City	:	IRVING
State	:	TX
Zip	:	75062-3931
Country	:	US
Telephone Number	:	214-845-4500
Fax Number	:	214-845-4501

Provider Business Practice Location Address
First Line	:	11200 DISCOVERY BAY DRIVE
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584
Country	:	US
Telephone Number	:	713-436-3941
Fax Number	:	713-436-4159

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHAD ANDERSON
Credential	:
Telephone Number	:	214-845-4500

Provider Enumeration Date	:	03/07/2012
Last Update Date	:	03/07/2012

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