Provider Demographics
NPI:1336409150
Name:MEMORIAL COUNTRY PLACE INC.
Entity Type:Organization
Organization Name:MEMORIAL COUNTRY PLACE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-382-6473
Mailing Address - Street 1:214 LAUREL GATE TER
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1266
Mailing Address - Country:US
Mailing Address - Phone:832-382-6473
Mailing Address - Fax:
Practice Address - Street 1:783 COUNTRY PLACE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-5533
Practice Address - Country:US
Practice Address - Phone:832-382-6473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-26
Last Update Date:2012-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare