Provider Demographics
NPI:1487078168
Name:HMG PARK MANOR OF FRIENDSWOOD, LLC
Entity type:Organization
Organization Name:HMG PARK MANOR OF FRIENDSWOOD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:NITA
Authorized Official - Middle Name:
Authorized Official - Last Name:RENEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-419-5520
Mailing Address - Street 1:4 WATERWAY SQUARE PLACE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2695
Mailing Address - Country:US
Mailing Address - Phone:281-419-5520
Mailing Address - Fax:281-419-5527
Practice Address - Street 1:1500 SUNSET DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-4724
Practice Address - Country:US
Practice Address - Phone:281-992-4300
Practice Address - Fax:281-992-0964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675744Medicare Oscar/Certification