MEDICARE: QUALITY SENIOR HOUSING FOUNDATION OF EAST TEXAS 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

General Provider Information

NPI Number	:	1942878087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY SENIOR HOUSING FOUNDATION OF EAST TEXAS INC

Provider Business Mailing Address
First Line	:	1004 E COKE RD # B
Second Line	:
City	:	WINNSBORO
State	:	TX
Zip	:	75494-3536
Country	:	US
Telephone Number	:	817-454-5561
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 W 1ST ST STE 400
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-2743
Country	:	US
Telephone Number	:	817-454-5561
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT VPO
Name	:	KATIE BAILEY
Credential	:
Telephone Number	:	817-454-5561

Provider Enumeration Date	:	06/15/2021
Last Update Date	:	06/15/2021

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