Provider Demographics
NPI:1114186780
Name:ADA'S PERSONAL CARE HOME
Entity Type:Organization
Organization Name:ADA'S PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:DEBBIE
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-890-5282
Mailing Address - Street 1:2015 EASTFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3611
Mailing Address - Country:US
Mailing Address - Phone:281-438-1677
Mailing Address - Fax:281-438-5853
Practice Address - Street 1:2015 EASTFIELD CIR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3611
Practice Address - Country:US
Practice Address - Phone:281-438-1677
Practice Address - Fax:281-438-5853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-08
Last Update Date:2008-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101283310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101283OtherTDHS LICENSE