MEDICARE: MEMORIAL HERMANN CONTINUING CARE CORPORATION

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	111986	TX

General Provider Information

NPI Number	:	1619902475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL HERMANN CONTINUING CARE CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 301208
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75303-1208
Country	:	US
Telephone Number	:	713-338-4127
Fax Number	:	713-338-4158

Provider Business Practice Location Address
First Line	:	3033 GESSNER DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77080-1000
Country	:	US
Telephone Number	:	713-460-8222
Fax Number	:	713-338-4158

Authorized Official
Title or Position	:	CFO
Name	:	MR. DENNIS LARAWAY
Credential	:
Telephone Number	:	713-242-2707

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	06/27/2014

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