Organization
OUTREACH ASSISTED LIVING FACILITY 2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAIR VIVARD CLARKE LBSW (OWNER)
(713) 459-1753
Entity
Organization
Contact information
Practice address
5010 RIDGEWAY DR, HOUSTON, TX 77033-3541
(713) 459-1753
(713) 988-5323
Mailing address
5010 RIDGEWAY DR, HOUSTON, TX 77033-3541
(713) 731-0645
(713) 998-5323
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
117656 VENDOR 100958
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10026531
LTC PROVIDER
TX
Enumeration date
05/03/2007
Last updated
08/22/2020
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