Provider Demographics
NPI:1407060262
Name:LAKEWOOD 24 HR PERSONAL HEALTH CARE
Entity type:Organization
Organization Name:LAKEWOOD 24 HR PERSONAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:713-633-3609
Mailing Address - Street 1:PO BOX 23054
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77228-3054
Mailing Address - Country:US
Mailing Address - Phone:713-633-3609
Mailing Address - Fax:713-631-8476
Practice Address - Street 1:8416 MESA DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77028-2003
Practice Address - Country:US
Practice Address - Phone:713-633-3609
Practice Address - Fax:713-631-8476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118267310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility