Provider Demographics
NPI:1316219918
Name:HEAVENLY MANOR I
Entity Type:Organization
Organization Name:HEAVENLY MANOR I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH CARE SERVICES ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-359-8273
Mailing Address - Street 1:14463 BENNINGCREST LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-7527
Mailing Address - Country:US
Mailing Address - Phone:713-359-8273
Mailing Address - Fax:
Practice Address - Street 1:12511 DONEGAL WAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-2809
Practice Address - Country:US
Practice Address - Phone:713-359-8273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility