Provider Demographics
NPI:1225651417
Name:MONARCH SERIES SOUTH LLC
Entity Type:Organization
Organization Name:MONARCH SERIES SOUTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TARO
Authorized Official - Middle Name:
Authorized Official - Last Name:WICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:832-620-1225
Mailing Address - Street 1:3326 RUSHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2278
Mailing Address - Country:US
Mailing Address - Phone:832-620-1225
Mailing Address - Fax:
Practice Address - Street 1:9616 BECKLEY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-4641
Practice Address - Country:US
Practice Address - Phone:281-405-9764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility