Provider Demographics
NPI:1316584642
Name:VILLAGE CARE HOMES, LLC
Entity Type:Organization
Organization Name:VILLAGE CARE HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-674-0100
Mailing Address - Street 1:1010 S MAGNOLIA BLVD STE L
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-8550
Mailing Address - Country:US
Mailing Address - Phone:832-674-0100
Mailing Address - Fax:832-674-0100
Practice Address - Street 1:414 STEPHEN F AUSTIN DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77302-3140
Practice Address - Country:US
Practice Address - Phone:832-674-0100
Practice Address - Fax:832-674-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149088OtherHHSC LICENSE #
TX150100OtherHHSC LICENSE #
TX107053OtherHHSC FACILITY ID #
TX107077OtherHHSC FACILITY ID #
TX149349OtherHHSC LICENSE #
TX307128OtherHHSC LICENSE #
TX107052OtherHHSC FACILITY ID #
TX105425OtherHHSC FACILITY ID #