MEDICARE: MSB PERSONAL ASSISTANT SERVICES, LLC

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	251E00000X	Home Health Agency	008967	TX

General Provider Information

NPI Number	:	1386771095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MSB PERSONAL ASSISTANT SERVICES, LLC

Provider Business Mailing Address
First Line	:	16868 ROYAL CREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2529
Country	:	US
Telephone Number	:	281-335-4882
Fax Number	:	281-984-7471

Provider Business Practice Location Address
First Line	:	1120 NASA PKWY STE 420
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3363
Country	:	US
Telephone Number	:	281-335-4882
Fax Number	:	281-335-5514

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MS. MARSENE S BOLDT
Credential	:	RN
Telephone Number	:	281-335-4882

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	10/10/2013

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