1487078168 NPI number — HMG PARK MANOR OF FRIENDSWOOD, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487078168 NPI number — HMG PARK MANOR OF FRIENDSWOOD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HMG PARK MANOR OF FRIENDSWOOD, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487078168
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 WATERWAY SQUARE PLACE
Provider Second Line Business Mailing Address:
SUITE 350
Provider Business Mailing Address City Name:
THE WOODLANDS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77380-2695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-419-5520
Provider Business Mailing Address Fax Number:
281-419-5527

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 SUNSET DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRIENDSWOOD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77546-4724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-992-4300
Provider Business Practice Location Address Fax Number:
281-992-0964
Provider Enumeration Date:
02/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RENEAU
Authorized Official First Name:
NITA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE ASSISTANT
Authorized Official Telephone Number:
281-419-5520

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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