Provider Demographics
NPI:1386710606
Name:ALL GOD'S PEOPLE ASSISTED LIVING HOME
Entity type:Organization
Organization Name:ALL GOD'S PEOPLE ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:C LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:713-433-3088
Mailing Address - Street 1:3903 DARLINGHURST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-5525
Mailing Address - Country:US
Mailing Address - Phone:713-433-3088
Mailing Address - Fax:713-433-3088
Practice Address - Street 1:3903 DARLINGHURST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-5525
Practice Address - Country:US
Practice Address - Phone:713-433-3088
Practice Address - Fax:713-433-3088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000010309310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1425258-01Medicaid
TX223191OtherRN LICENSE