Provider Demographics
NPI:1083846497
Name:COMPASSIONATE CARE SENIOR LIVING
Entity Type:Organization
Organization Name:COMPASSIONATE CARE SENIOR LIVING
Other - Org Name:COMPASSIONATE CARE SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-232-9144
Mailing Address - Street 1:555 STEPHEN F AUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77302-1204
Mailing Address - Country:US
Mailing Address - Phone:936-232-9144
Mailing Address - Fax:936-271-9413
Practice Address - Street 1:607 JEB STUART LN
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77302-3813
Practice Address - Country:US
Practice Address - Phone:936-271-3263
Practice Address - Fax:936-271-9413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)