Provider Demographics
NPI:1114626108
Name:PHYSICIANS INDEPENDENT LIVING GROUP HOME INC
Entity Type:Organization
Organization Name:PHYSICIANS INDEPENDENT LIVING GROUP HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:UROOJ
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-809-3664
Mailing Address - Street 1:14045 NORTH FWY
Mailing Address - Street 2:BLDG1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090
Mailing Address - Country:US
Mailing Address - Phone:832-426-3190
Mailing Address - Fax:
Practice Address - Street 1:14045 NORTH FWY
Practice Address - Street 2:BLDG1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090
Practice Address - Country:US
Practice Address - Phone:832-426-3190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility