Provider Demographics
NPI:1841600236
Name:ROGERS, TOMIKA
Entity Type:Individual
Prefix:
First Name:TOMIKA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-5131
Mailing Address - Country:US
Mailing Address - Phone:832-967-5971
Mailing Address - Fax:936-494-0460
Practice Address - Street 1:1820 S 3RD ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-5131
Practice Address - Country:US
Practice Address - Phone:832-967-5971
Practice Address - Fax:936-494-0460
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home