Provider Demographics
NPI:1386198315
Name:SENIOR RETREAT LLC
Entity Type:Organization
Organization Name:SENIOR RETREAT LLC
Other - Org Name:SENIOR COMMUNITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VAY
Authorized Official - Middle Name:MIU
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-637-4302
Mailing Address - Street 1:7850 PARKWOOD CIRCLE DR STE A-1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-6760
Mailing Address - Country:US
Mailing Address - Phone:713-637-4302
Mailing Address - Fax:713-637-4803
Practice Address - Street 1:7850 PARKWOOD CIRCLE DR STE A-1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-6760
Practice Address - Country:US
Practice Address - Phone:713-637-4302
Practice Address - Fax:713-637-4803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX146665261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care