MEDICARE: KATHLEEN MOSBY

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	100075	TX

General Provider Information

NPI Number	:	1154535193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHLEEN MOSBY

Provider Business Mailing Address
First Line	:	PO BOX 11189
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77293-1189
Country	:	US
Telephone Number	:	713-259-6470
Fax Number	:	281-446-3392

Provider Business Practice Location Address
First Line	:	6021 BRETSHIRE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-3211
Country	:	US
Telephone Number	:	713-635-3700
Fax Number	:	281-446-3392

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. KATHLEEN MOSBY
Credential	:
Telephone Number	:	713-259-6470

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/10/2008

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