MEDICARE: MR. DEMOND ANDERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251S00000X	Community/Behavioral Health Agency
3	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
4	320700000X	Physical Disabilities Residential Treatment Facility
5	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
6	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1053242107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEMOND ANDERSON

Provider Business Mailing Address
First Line	:	3438 N PEACH HOLLOW CIR
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-2101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6402 GOFORTH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77021-4118
Country	:	US
Telephone Number	:	713-000-0000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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Directions to “ MR. DEMOND ANDERSON ” Practice Location

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