Provider Demographics
NPI:1720489115
Name:ASSEMBLY OF SENIOR CITIZENS LIVING HOME FACILITY, LLC
Entity Type:Organization
Organization Name:ASSEMBLY OF SENIOR CITIZENS LIVING HOME FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:OSEMWENGIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-373-6316
Mailing Address - Street 1:8822 CHACO HILL LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-5021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8822 CHACO HILL LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-5021
Practice Address - Country:US
Practice Address - Phone:832-373-6316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness