MEDICARE: 1212 SENIOR CARE, INC.

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1528353935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1212 SENIOR CARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 84290
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-0016
Country	:	US
Telephone Number	:	281-386-8192
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 WESTHEIMER RD
Second Line	:	SUITE 186
City	:	HOUSTON
State	:	TX
Zip	:	77027-4415
Country	:	US
Telephone Number	:	713-403-2273
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS HAROLD RAY CORKRAN
Credential	:
Telephone Number	:	281-386-8192

Provider Enumeration Date	:	06/14/2011
Last Update Date	:	06/14/2011

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