MEDICARE: RIVER OAKS CONCIERGE ADULT CARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1790338127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER OAKS CONCIERGE ADULT CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	1940 FOUNTAIN VIEW DR # 401
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-3206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 FOUNTAIN VIEW DR APT 1J
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-3605
Country	:	US
Telephone Number	:	832-715-4445
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CASSIE WILSON
Credential	:
Telephone Number	:	832-715-4445

Provider Enumeration Date	:	07/24/2019
Last Update Date	:	07/24/2019

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