Provider Demographics
NPI:1609355700
Name:PROVIDENCE ASSISTED LIVING HOME, INC.
Entity Type:Organization
Organization Name:PROVIDENCE ASSISTED LIVING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:IGWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-980-2977
Mailing Address - Street 1:8202 ASH GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-6518
Mailing Address - Country:US
Mailing Address - Phone:281-980-2977
Mailing Address - Fax:281-242-2265
Practice Address - Street 1:8202 ASH GARDEN CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-6518
Practice Address - Country:US
Practice Address - Phone:281-980-2977
Practice Address - Fax:281-242-2265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health