Provider Demographics
NPI:1093951873
Name:A NEW HOME FOR MOM & DAD
Entity Type:Organization
Organization Name:A NEW HOME FOR MOM & DAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKERBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-258-5433
Mailing Address - Street 1:24824 STANOLIND RD
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3170
Mailing Address - Country:US
Mailing Address - Phone:832-258-5433
Mailing Address - Fax:281-516-0991
Practice Address - Street 1:600 MASON ST
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4477
Practice Address - Country:US
Practice Address - Phone:832-258-5433
Practice Address - Fax:281-516-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-27
Last Update Date:2008-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness