Sr Sam

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

Legal business name

SR SAM

Practice address

502 N 5TH St
La Porte, TX 77571-3310

Phone

(832) 677-2248

Fax

(281) 471-1263

NPI assigned

Sep 16, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Constance K Gordon

Title

Owner

Phone

(832) 677-2248

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379289600000",
    "number": "1457787079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 N 5TH ST",
            "city": "LA PORTE",
            "state": "TX",
            "postal_code": "775713310",
            "telephone_number": "832-677-2248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 N 5TH ST",
            "city": "LA PORTE",
            "state": "TX",
            "postal_code": "775713310",
            "telephone_number": "832-677-2248",
            "fax_number": "281-471-1263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SR SAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-16",
        "last_updated": "2013-09-16",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "CONSTANCE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "832-677-2248"
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "TX",
            "license": null,
            "primary": true
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "TX",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.