MEDICARE: REAL COMFORT LIVING LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	310400000X	Assisted Living Facility
2	3104A0625X	Assisted Living Facility (Mental Illness)
3	3104A0630X	Assisted Living Facility (Behavioral Disturbances)
4	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1194261511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REAL COMFORT LIVING LLC

Provider Business Mailing Address
First Line	:	10103 FONDREN RD STE 474
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-4671
Country	:	US
Telephone Number	:	832-582-6111
Fax Number	:	832-582-5563

Provider Business Practice Location Address
First Line	:	17014 QUAIL BEND DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77489-6158
Country	:	US
Telephone Number	:	281-300-8765
Fax Number	:	281-437-6622

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CHRISTOPHER C EKWEALOR
Credential	:
Telephone Number	:	832-850-8761

Provider Enumeration Date	:	01/09/2017
Last Update Date	:	12/18/2024

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