Active NPI
Johnnetta Matrice Nichols
- Assisted Living Facility
- Houston, TX
National Provider Identifier
1861636896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- License
- 102737
- Practice address
- 8209 N. Main St.
Houston, TX 77022 - Phone
- (713) 692-1414
- Fax
- (713) 692-2157
- NPI assigned
- Apr 21, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | |||
| Assisted Living Facility | 310400000X | 102737 | TX | Primary |
Addresses
Primary practice location
8209 N. Main St.
Houston, TX 77022
Mailing address
8209 N. Main St.
Houston, TX 77022
Phone (713) 692-1414
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| F500193420 | Medicaid | TX | |
| 1861636896 | Medicaid | TX | |
| 205828380 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102737 | TX | MD | Assisted Living Facility |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Loving Care Assisted Living Home | Assisted Living Facility | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Assisted Living Facility
- Houston, TX
- NPI 1720569429
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714089600000",
"number": "1861636896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8209 N. MAIN ST.",
"city": "HOUSTON",
"state": "TX",
"postal_code": "77022",
"telephone_number": "713-692-1414",
"fax_number": "713-692-2157"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8209 N. MAIN ST.",
"city": "HOUSTON",
"state": "TX",
"postal_code": "77022",
"telephone_number": "713-692-1414",
"fax_number": "713-692-2157"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "JOHNNETTA",
"middle_name": "MATRICE",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-04-21",
"last_updated": "2024-04-26",
"certification_date": "2024-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": null,
"license": null,
"primary": false
},
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "TX",
"license": "102737",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "F500193420",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1861636896",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "205828380",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.