MEDICARE: GOOD LIVING COMMUNITY CARE INC

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

General Provider Information

NPI Number	:	1114045333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD LIVING COMMUNITY CARE INC

Provider Business Mailing Address
First Line	:	5719 DOLORES ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-5711
Country	:	US
Telephone Number	:	713-953-0848
Fax Number	:	713-953-0652

Provider Business Practice Location Address
First Line	:	5719 DOLORES ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-5711
Country	:	US
Telephone Number	:	713-953-0848
Fax Number	:	713-953-0652

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. URAIWAN P TESFAYE
Credential	:
Telephone Number	:	832-693-8233

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	08/22/2007

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