Provider Demographics
NPI:1790905339
Name:VIP ASSISTED LIVING
Entity Type:Organization
Organization Name:VIP ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-216-7504
Mailing Address - Street 1:6703 NEW YORK ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-5047
Mailing Address - Country:US
Mailing Address - Phone:713-747-6600
Mailing Address - Fax:
Practice Address - Street 1:6703 NEW YORK ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-5047
Practice Address - Country:US
Practice Address - Phone:713-747-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113641310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility