Provider Demographics
NPI:1073887196
Name:PEARLAND MEMORY CARE, LLC
Entity Type:Organization
Organization Name:PEARLAND MEMORY CARE, LLC
Other - Org Name:AUTUMN LEAVES OF PEARLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-845-4500
Mailing Address - Street 1:545 E JOHN CARPENTER FWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3931
Mailing Address - Country:US
Mailing Address - Phone:214-845-4500
Mailing Address - Fax:214-845-4501
Practice Address - Street 1:11200 DISCOVERY BAY DRIVE
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584
Practice Address - Country:US
Practice Address - Phone:713-436-3941
Practice Address - Fax:713-436-4159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104926310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility