Provider Demographics
NPI:1205552320
Name:BAILEY, FAYLISA DANIELLE (HEALTHCARE PROVIDER,)
Entity type:Individual
Prefix:MRS
First Name:FAYLISA
Middle Name:DANIELLE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:HEALTHCARE PROVIDER,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4218
Mailing Address - Country:US
Mailing Address - Phone:832-901-6806
Mailing Address - Fax:281-817-4649
Practice Address - Street 1:408 N HOLLY AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4218
Practice Address - Country:US
Practice Address - Phone:832-901-6806
Practice Address - Fax:281-817-4649
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX501144206Medicaid