Provider Demographics
NPI:1891936472
Name:BRAEBURN VALLEY PERSONAL CARE HOME
Entity Type:Organization
Organization Name:BRAEBURN VALLEY PERSONAL CARE HOME
Other - Org Name:BRAEBURN VALLEY PERSONAL CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-433-7311
Mailing Address - Street 1:8215 BRAESVIEW LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-1229
Mailing Address - Country:US
Mailing Address - Phone:832-433-7311
Mailing Address - Fax:832-433-7311
Practice Address - Street 1:8215 BRAESVIEW LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-1229
Practice Address - Country:US
Practice Address - Phone:832-433-7311
Practice Address - Fax:832-433-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No385H00000XRespite Care FacilityRespite Care