Provider Demographics
NPI:1972981777
Name:PANACHE' ASSISTED LIVING/ PERSONAL CARE, LLC
Entity Type:Organization
Organization Name:PANACHE' ASSISTED LIVING/ PERSONAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-264-0321
Mailing Address - Street 1:5230 PANAY PARK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77048-4063
Mailing Address - Country:US
Mailing Address - Phone:713-264-0321
Mailing Address - Fax:713-264-0321
Practice Address - Street 1:5230 PANAY PARK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77048-4063
Practice Address - Country:US
Practice Address - Phone:713-264-0321
Practice Address - Fax:713-264-0321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX596482163W00000X, 251B00000X, 251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing Care
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care