Provider Demographics
NPI:1235461161
Name:R. GOLDEN MEADOW PERSONAL CARE CENTEER
Entity Type:Organization
Organization Name:R. GOLDEN MEADOW PERSONAL CARE CENTEER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMEZE
Authorized Official - Middle Name:E
Authorized Official - Last Name:AKHIONBARE-HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-433-8880
Mailing Address - Street 1:4411 TIDEWATER DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-4343
Mailing Address - Country:US
Mailing Address - Phone:713-433-8880
Mailing Address - Fax:
Practice Address - Street 1:4411 TIDEWATER DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-4343
Practice Address - Country:US
Practice Address - Phone:713-433-8880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125103311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home