MODERN VINTAGE RESIDENTIAL CARE, LLC.


Address: 4015 Alexis Tate Cir, Missouri City, TX 77459-5039
Phone: 8066811122

MODERN VINTAGE RESIDENTIAL CARE, LLC. (NPI# 1790394161) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1790394161
Entity Type Organization
Organization Name MODERN VINTAGE RESIDENTIAL CARE, LLC.
Practice Address 4015 Alexis Tate Cir
Missouri City
TX 77459-5039
Practice Telephone 8066811122
Mailing Telephone 8066811122
Enumeration Date 2020-07-30
Last Update Date 2020-07-30
Authorized Official Name DEREK WAYNE THOMPSON (OWNER)
Authorized Official Telephone 8066811122
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities Residential Treatment Facilities

Office Location

Street Address 4015 ALEXIS TATE CIR
City MISSOURI CITY
State TX
Zip Code 77459-5039

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1942801337 Dynamik Transformations, LLC Social Worker 3522 Duncaster Dr, Missouri City, TX 77459 2020-11-03
1720606163 Wonderfully Made Pediatrics, Pllc Pediatrics 8035 Highway 6 Ste 100, Missouri City, TX 77459 2020-07-13
1326608522 Kyle Macdonald Counselor 9029 Sienna Ranch Road, Missouri City, TX 77459 2019-06-19
1275004947 Andrea Christina Bland Case Manager/Care Coordinator 3426 Covey Trail Dr, Missouri City, TX 77459 2018-12-06
1477035814 Golden Williams Registered Nurse 4502 Riverstone Boulevard, Missouri City, TX 77459 2018-09-01
1457831216 Tania Leida Karmout Physical Therapist 4710 Lexington Boulevard, Missouri City, TX 77459 2018-08-20
1457831513 Laila Dalope Clinic/Center 811 Sienna Springs Blvd, 521, Missouri City, TX 77459 2018-08-17
1477039196 Tionyce Johnson Behavior Technician 3552 Fm 1092, Missouri City, TX 77459 2018-07-16
1861990681 Nitta Ogu Nurse Practitioner 3631 John Hancock Lane, Missouri City, TX 77459 2018-01-26
1881100998 Higden Dialysis LLC Clinic/Center 9340 Highway 6, Suite 400, Missouri City, TX 77459 2017-12-27
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Taxonomy Information

Taxonomy Code 320600000X
Grouping Residential Treatment Facilities
Classification Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities

Taxonomy Definition

A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently.
Notes: [7/1/2003: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1407314966 Belfry Care Homes LLC Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 4719 Creek Point Ln, Missouri City, TX 77459-6716 2019-03-04
1891251930 Kelva Wayne-grady Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 1235 Mossridge Dr, Missouri City, TX 77489-4128 2019-02-13
1518361591 Sammy Smith Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 1722 Oakbury Dr, Missouri City, TX 77489-2160 2014-10-20
1427374693 Above All Else Healthcare Resources Inc Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 2527 Village Square Dr, Missouri City, TX 77489-4093 2010-04-13
1114085560 Elnas, Inc Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 3943 Southern Bnd, Missouri City, TX 77459-6797 2006-12-05
1396309720 Belfry Estates LLC Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 4719 Creek Point Ln, Missouri City, TX 77459-6716 2019-05-01
1407237969 N2 Care Services Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 2651 Cartwright Rd, Missouri City, TX 77459-2635 2015-06-10
1073946752 Bethseda Assisted Living Facility Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 7315 Towerview Ln, Missouri City, TX 77489-2433 2013-08-16

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NPI Name Taxonomy Address Enumeration
1619581782 Joyful Psalm Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 1354 Ravenwood Ct, Crowley, TX 76036-3472 2020-09-04
1285253856 1 Care Premier Services LLC Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 340 N Sam Houston Pkwy E Ste A247, Houston, TX 77060-3305 2020-04-13
1568093888 James Micah Howard Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 11911 Lakewood Trl, Tomball, TX 77377-8563 2020-01-27
1518507110 Gems Residence LLC Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 5810 Liverpool St, Aubrey, TX 76227-1909 2020-01-10
1366081812 Abundant Care Services LLC Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 1100 Maxfield St, Waco, TX 76705-2967 2020-01-02
1306487426 Fort Healthcare LLC Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 5833 Oakbend Trail, #200, Fort Worth, TX 76132-3900 2019-09-30
1144877481 Boniswa Portia Maduna Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 8000 Cook Rd Apt 1109, Houston, TX 77072-3939 2019-08-21
1871148171 Kenneth Allen Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 135 E Menefee St, Lufkin, TX 75901-4701 2019-08-05
1124673553 1st A & M Healthcare Services Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 504 Spicewood Dr, Desoto, TX 75115-1485 2019-08-02
1558922823 Primeway Consulting LLC Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 2712 Ferdinand, Grand Prairie, TX 75054-5519 2019-06-26
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Competitor

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City MISSOURI CITY
Zip Code 77459

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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