Provider Demographics
NPI:1588805162
Name:DOWNHOMEPERSONAL CARE
Entity Type:Organization
Organization Name:DOWNHOMEPERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:LAVERN
Authorized Official - Last Name:MANTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-351-0124
Mailing Address - Street 1:27521 CALVERT RD
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-6172
Mailing Address - Country:US
Mailing Address - Phone:281-290-8542
Mailing Address - Fax:
Practice Address - Street 1:27521 CALVERT RD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-6172
Practice Address - Country:US
Practice Address - Phone:281-351-0124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12363955310400000X, 320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities