MEDICARE: BRAESWOOD PERSONAL CARE HOMES 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	310400000X	Assisted Living Facility	119618	TX

General Provider Information

NPI Number	:	1710107370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAESWOOD PERSONAL CARE HOMES INC

Provider Business Mailing Address
First Line	:	3519 S BRAESWOOD BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-3758
Country	:	US
Telephone Number	:	713-666-6545
Fax Number	:

Provider Business Practice Location Address
First Line	:	3519 S BRAESWOOD BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-3758
Country	:	US
Telephone Number	:	713-666-6545
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. SUSAN DIFILIPPO
Credential	:
Telephone Number	:	713-666-6545

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	08/22/2020

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