MEDICARE: SENIOR CITIZENS BUREAU

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	311Z00000X	Custodial Care Facility	143030	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	143030	OTHER	TX	DADS LICENSE

General Provider Information

NPI Number	:	1295106649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR CITIZENS BUREAU

Provider Business Mailing Address
First Line	:	9406 FERN WOOD FRST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-6892
Country	:	US
Telephone Number	:	713-291-1567
Fax Number	:

Provider Business Practice Location Address
First Line	:	9406 FERN WOOD FRST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-6892
Country	:	US
Telephone Number	:	713-291-1567
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ASHEVA PHILLIPS
Credential	:
Telephone Number	:	832-478-9333

Provider Enumeration Date	:	10/12/2015
Last Update Date	:	04/13/2016

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Directions to “SENIOR CITIZENS BUREAU ” Practice Location

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