MEDICARE: ALDINE COMMUNITY CARE CENTER, 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	261QA0600X	Adult Day Care Clinic/Center	101964	TX
2	310400000X	Assisted Living Facility	101963	TX

General Provider Information

NPI Number	:	1114129582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALDINE COMMUNITY CARE CENTER, INC

Provider Business Mailing Address
First Line	:	10110 AIRLINE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77037-1406
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10110 AIRLINE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77037-1406
Country	:	US
Telephone Number	:	281-820-5226
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JESSE DUNN
Credential	:
Telephone Number	:	281-820-5226

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	06/23/2008

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