MEDICARE: ALL GOD'S PEOPLE ASSISTED LIVING HOME

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	000010309	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	223191	OTHER	TX	RN LICENSE

General Provider Information

NPI Number	:	1386710606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL GOD'S PEOPLE ASSISTED LIVING HOME

Provider Business Mailing Address
First Line	:	3903 DARLINGHURST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-5525
Country	:	US
Telephone Number	:	713-433-3088
Fax Number	:	713-433-3088

Provider Business Practice Location Address
First Line	:	3903 DARLINGHURST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-5525
Country	:	US
Telephone Number	:	713-433-3088
Fax Number	:	713-433-3088

Authorized Official
Title or Position	:	OWNER
Name	:	C LOIS BRADLEY
Credential	:	R.N.,B.S.N
Telephone Number	:	713-433-3088

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	06/13/2008

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