MEDICARE: CHAMPIONS FOR LIFE PERSONAL CARE FACILITY

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	187911	TX

General Provider Information

NPI Number	:	1699042093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAMPIONS FOR LIFE PERSONAL CARE FACILITY

Provider Business Mailing Address
First Line	:	1506 ELK RIVER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-1144
Country	:	US
Telephone Number	:	832-797-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1506 ELK RIVER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-1144
Country	:	US
Telephone Number	:	832-797-1600
Fax Number	:

Authorized Official
Title or Position	:	LICENSED VOCATIONAL NURSE (LVN)
Name	:	MRS. RACHEL MARIE NAVA
Credential	:	NURSE
Telephone Number	:	832-352-5203

Provider Enumeration Date	:	11/29/2011
Last Update Date	:	11/29/2011

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