Provider Demographics
NPI:1013157320
Name:MEMORIAL LONG CARE, INC.
Entity Type:Organization
Organization Name:MEMORIAL LONG CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NYDIA
Authorized Official - Middle Name:IVETTE
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-316-2403
Mailing Address - Street 1:14027 MEMORIAL DR
Mailing Address - Street 2:# 296
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-6826
Mailing Address - Country:US
Mailing Address - Phone:832-316-2403
Mailing Address - Fax:
Practice Address - Street 1:14027 MEMORIAL DR
Practice Address - Street 2:# 296
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-6826
Practice Address - Country:US
Practice Address - Phone:832-316-2403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE15757Medicare UPIN
TXF83509Medicare UPIN