MEDICARE: CORMFORT OF MIND SERVICES 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1851616841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORMFORT OF MIND SERVICES INC

Provider Business Mailing Address
First Line	:	3203 BIRCH PARK LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77073-3120
Country	:	US
Telephone Number	:	713-582-7156
Fax Number	:

Provider Business Practice Location Address
First Line	:	3203 BIRCH PARK LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77073-3120
Country	:	US
Telephone Number	:	713-582-7156
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MRS. DEBRA RACHELLE DIRDEN
Credential	:
Telephone Number	:	713-582-7156

Provider Enumeration Date	:	04/01/2010
Last Update Date	:	04/01/2010

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