Provider Demographics
NPI:1144423708
Name:KATHLEEN MOSBY
Entity Type:Organization
Organization Name:KATHLEEN MOSBY
Other - Org Name:ANGEL OF LOVE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-635-3700
Mailing Address - Street 1:PO BOX 62262
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77205-2262
Mailing Address - Country:US
Mailing Address - Phone:713-635-3700
Mailing Address - Fax:281-781-7011
Practice Address - Street 1:7638 CABOT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77016-3918
Practice Address - Country:US
Practice Address - Phone:713-259-6470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118359310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1012034Medicaid