MEDICARE: 3D MANAGEMENT, 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	126242	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	126242	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1821231960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3D MANAGEMENT, INC

Provider Business Mailing Address
First Line	:	12811 PLEASANT VALLEY DR
Second Line	:
City	:	ROSHARON
State	:	TX
Zip	:	77583-6221
Country	:	US
Telephone Number	:	281-369-2067
Fax Number	:	281-369-2433

Provider Business Practice Location Address
First Line	:	12811 PLEASANT VALLEY DR
Second Line	:
City	:	ROSHARON
State	:	TX
Zip	:	77583-6221
Country	:	US
Telephone Number	:	281-369-2067
Fax Number	:	281-369-2433

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. DORIS JONES
Credential	:
Telephone Number	:	281-369-2067

Provider Enumeration Date	:	04/17/2009
Last Update Date	:	05/04/2009

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