Provider Demographics
NPI:1528353935
Name:1212 SENIOR CARE, INC.
Entity type:Organization
Organization Name:1212 SENIOR CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:CORKRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-386-8192
Mailing Address - Street 1:PO BOX 84290
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-0016
Mailing Address - Country:US
Mailing Address - Phone:281-386-8192
Mailing Address - Fax:
Practice Address - Street 1:4200 WESTHEIMER RD
Practice Address - Street 2:SUITE 186
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-4415
Practice Address - Country:US
Practice Address - Phone:713-403-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care