MEDICARE: BROGANS HEALTH AND RESIDENT 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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1699228015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROGANS HEALTH AND RESIDENT SERVICES LLC

Provider Business Mailing Address
First Line	:	2855 MANGUM RD
Second Line	:	360
City	:	HOUSTON
State	:	TX
Zip	:	77092-7493
Country	:	US
Telephone Number	:	281-964-5077
Fax Number	:

Provider Business Practice Location Address
First Line	:	2855 MANGUM RD
Second Line	:	360
City	:	HOUSTON
State	:	TX
Zip	:	77092-7493
Country	:	US
Telephone Number	:	281-964-5077
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DEBRA RILEY
Credential	:
Telephone Number	:	281-964-5077

Provider Enumeration Date	:	08/02/2016
Last Update Date	:	08/02/2016

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