Provider Demographics
NPI:1336696020
Name:2ND HOME SENIOR LIFESTYLE CENTER, LLC
Entity Type:Organization
Organization Name:2ND HOME SENIOR LIFESTYLE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:281-251-9293
Mailing Address - Street 1:17523 E STRACK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-5217
Mailing Address - Country:US
Mailing Address - Phone:281-251-9293
Mailing Address - Fax:832-602-5534
Practice Address - Street 1:17523 E STRACK DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-5217
Practice Address - Country:US
Practice Address - Phone:281-251-9293
Practice Address - Fax:832-602-5534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144124261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care