1457369472 NPI number — SPECIAL TEXAS HOME INC

Table of content: (NPI 1457369472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457369472 NPI number — SPECIAL TEXAS HOME INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIAL TEXAS HOME INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BURNING TREE LIVING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457369472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4115 GALVESTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77017-2518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-475-2228
Provider Business Mailing Address Fax Number:
713-475-2332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4902 BURNING TREE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYTOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77521-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-838-1518
Provider Business Practice Location Address Fax Number:
713-475-2332
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARRELL
Authorized Official First Name:
JERRINE
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
218-445-6470

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  116631 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 45H114 . This is a "TEXAS" identifier . This identifiers is of the category "OTHER".




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