Provider Demographics
NPI:1912617176
Name:MCCOWAN, ALICE
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:MCCOWAN
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 1:407 AVENUE F CONROE
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301
Mailing Address - Country:US
Mailing Address - Phone:832-736-4085
Mailing Address - Fax:
Practice Address - Street 1:407 AVE F CONROE TX
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301
Practice Address - Country:US
Practice Address - Phone:832-736-4085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility