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NPI Code Detail

MEDICARE: ALYCE ASSISTED LIVING

MEDICARE: ALYCE ASSISTED LIVING
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
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1720321110
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALYCE ASSISTED LIVING
Provider Business Mailing Address
First Line : 14007 RIVER KEG DR
Second Line :
City : HOUSTON
State : TX
Zip : 77083-6507
Country : US
Telephone Number : 281-799-0479
Fax Number :
Provider Business Practice Location Address
First Line : 14007 RIVER KEG DR
Second Line :
City : HOUSTON
State : TX
Zip : 77083-6507
Country : US
Telephone Number : 281-799-0479
Fax Number :
Authorized Official
Title or Position : OWNER/ADMINISTRATOR
Name : CAROL ETOAMA
Credential :
Telephone Number : 281-799-0479
Provider Enumeration Date : 04/03/2013
Last Update Date : 04/03/2013

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Directions to “ALYCE ASSISTED LIVING ” Practice Location

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