Provider Demographics
NPI:1790922367
Name:SILVERADO SENIOR LIVING OF TEXAS
Entity Type:Organization
Organization Name:SILVERADO SENIOR LIVING OF TEXAS
Other - Org Name:SILVERADO AT HOME - HOUSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:JEROME
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CMC
Authorized Official - Phone:832-249-9940
Mailing Address - Street 1:13810 CHAMPION FOREST DR
Mailing Address - Street 2:SUITE 147
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-1844
Mailing Address - Country:US
Mailing Address - Phone:832-249-9940
Mailing Address - Fax:832-249-9933
Practice Address - Street 1:13810 CHAMPION FOREST DR
Practice Address - Street 2:SUITE 147
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-1844
Practice Address - Country:US
Practice Address - Phone:832-249-9940
Practice Address - Fax:832-249-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010262251B00000X, 251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010262OtherSTATE LICENSE