Provider Demographics
NPI:1477109536
Name:SACRED SENIORS
Entity Type:Organization
Organization Name:SACRED SENIORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:936-439-6033
Mailing Address - Street 1:144 WOOD FARM RD
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77320-1742
Mailing Address - Country:US
Mailing Address - Phone:936-439-6033
Mailing Address - Fax:936-439-6033
Practice Address - Street 1:144 WOOD FARM RD
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77320-1742
Practice Address - Country:US
Practice Address - Phone:936-439-6033
Practice Address - Fax:936-439-6033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No251E00000XAgenciesHome Health
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care FacilityGroup - Single Specialty