MEDICARE: PREVAILING FAITH OUTREACH CENTER

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	101574	TX

General Provider Information

NPI Number	:	1336357243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVAILING FAITH OUTREACH CENTER

Provider Business Mailing Address
First Line	:	5423 GRACE POINT LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77048-1726
Country	:	US
Telephone Number	:	713-734-0848
Fax Number	:

Provider Business Practice Location Address
First Line	:	5423 GRACE POINT LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77048-1726
Country	:	US
Telephone Number	:	713-734-0848
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. NORMA T WILBURN
Credential	:
Telephone Number	:	713-734-0848

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	08/22/2020

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