Organization
SR SAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONSTANCE K GORDON (OWNER)
(832) 677-2248
Entity
Organization
Contact information
Practice address
502 N 5TH ST, LA PORTE, TX 77571-3310
(832) 677-2248
(281) 471-1263
Mailing address
502 N 5TH ST, LA PORTE, TX 77571-3310
(832) 677-2248
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
—
TX
311ZA0620X
Adult Care Home Facility
—
TX
Other
Enumeration date
09/16/2013
Last updated
09/16/2013
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