Provider Demographics
NPI:1730327206
Name:MY MOTHER'S PLACE INC
Entity type:Organization
Organization Name:MY MOTHER'S PLACE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ERICKA
Authorized Official - Middle Name:B
Authorized Official - Last Name:COUSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-294-5128
Mailing Address - Street 1:3344 FALCON GRV
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-2684
Mailing Address - Country:US
Mailing Address - Phone:512-294-5128
Mailing Address - Fax:
Practice Address - Street 1:3344 FALCON GRV
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2684
Practice Address - Country:US
Practice Address - Phone:512-294-5128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility