Provider Demographics
NPI:1194201830
Name:PIERI, CARMELO
Entity Type:Individual
Prefix:
First Name:CARMELO
Middle Name:
Last Name:PIERI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6942 FM 1960 RD E # 321
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2706
Mailing Address - Country:US
Mailing Address - Phone:832-368-7165
Mailing Address - Fax:
Practice Address - Street 1:1507 HAMLIN VALLEY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2417
Practice Address - Country:US
Practice Address - Phone:832-919-1129
Practice Address - Fax:888-283-8366
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131438310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131438OtherDEPARTMENT OF AGING AND DISABILITY