Provider Demographics
NPI:1629447172
Name:FISHER HAVEN ASSISTED LIVING CENTER
Entity Type:Organization
Organization Name:FISHER HAVEN ASSISTED LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DORETTA
Authorized Official - Middle Name:PERRO
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:8326-680-0860
Mailing Address - Street 1:2440 TEXAS PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-4207
Mailing Address - Country:US
Mailing Address - Phone:832-668-0860
Mailing Address - Fax:281-969-7587
Practice Address - Street 1:2440 TEXAS PKWY STE 140
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-4207
Practice Address - Country:US
Practice Address - Phone:832-668-0860
Practice Address - Fax:281-969-7587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102554310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility