MEDICARE: ROOMES PERSONAL CARE HOME

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	3104A0625X	Assisted Living Facility (Mental Illness)	126116	TX

General Provider Information

NPI Number	:	1093042756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOMES PERSONAL CARE HOME

Provider Business Mailing Address
First Line	:	6106 GRANDVALE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-1516
Country	:	US
Telephone Number	:	281-568-3239
Fax Number	:	281-545-2575

Provider Business Practice Location Address
First Line	:	6106 GRANDVALE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-1516
Country	:	US
Telephone Number	:	281-568-3239
Fax Number	:	281-545-2575

Authorized Official
Title or Position	:	CEO
Name	:	MRS. EVANGELINE ROOMES
Credential	:
Telephone Number	:	281-568-3239

Provider Enumeration Date	:	11/17/2009
Last Update Date	:	11/17/2009

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Directions to “ROOMES PERSONAL CARE HOME ” Practice Location

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