MEDICARE: FORT BEND COUNTY ADULT DAY CARE, 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	311ZA0620X	Adult Care Home Facility		TX

General Provider Information

NPI Number	:	1891800496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT BEND COUNTY ADULT DAY CARE, LLC

Provider Business Mailing Address
First Line	:	4402 MISTLETOE LN
Second Line	:
City	:	FRESNO
State	:	TX
Zip	:	77545-7878
Country	:	US
Telephone Number	:	713-502-0253
Fax Number	:	281-431-9474

Provider Business Practice Location Address
First Line	:	4402 MISTLETOE LN
Second Line	:
City	:	FRESNO
State	:	TX
Zip	:	77545-7878
Country	:	US
Telephone Number	:	713-502-0253
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. SUSAN ELIZABETH MCLEAN
Credential	:
Telephone Number	:	713-502-0253

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/22/2020

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