Provider Demographics
NPI:1245804954
Name:EXTENDED SENIOR CARE AND SERVICES
Entity Type:Organization
Organization Name:EXTENDED SENIOR CARE AND SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:IAZA
Authorized Official - Middle Name:
Authorized Official - Last Name:USMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:832-933-3444
Mailing Address - Street 1:101 S WOODSWAY ST W
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-1390
Mailing Address - Country:US
Mailing Address - Phone:832-933-3444
Mailing Address - Fax:
Practice Address - Street 1:101 S WOODSWAY ST W
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1390
Practice Address - Country:US
Practice Address - Phone:832-933-3444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility