Provider Demographics
NPI:1437486545
Name:HOME SWEET HOME RESIDENTIAL CARE FACIULITY FOR THE ELDERLY
Entity Type:Organization
Organization Name:HOME SWEET HOME RESIDENTIAL CARE FACIULITY FOR THE ELDERLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:S
Authorized Official - Last Name:VELASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-704-1164
Mailing Address - Street 1:PO BOX 983
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-0983
Mailing Address - Country:US
Mailing Address - Phone:281-704-1164
Mailing Address - Fax:
Practice Address - Street 1:12142 7TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5322
Practice Address - Country:US
Practice Address - Phone:281-704-1164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143306310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility