Provider Demographics
NPI:1700965167
Name:BENNETT, FLORENCE N
Entity Type:Individual
Prefix:MS
First Name:FLORENCE
Middle Name:N
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 300079
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77230-0079
Mailing Address - Country:US
Mailing Address - Phone:713-303-1325
Mailing Address - Fax:713-520-7623
Practice Address - Street 1:11122 COLEBROOK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-1922
Practice Address - Country:US
Practice Address - Phone:713-667-8307
Practice Address - Fax:713-520-7623
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 320900000X
TX311ZA0620X
TX86H320600000X
TXCOMPONENT CODE86H320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86H (001007690)Medicaid
TX86H (001007692)Medicaid