MEDICARE: CHOSEN JAY INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1407130982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOSEN JAY INC.

Provider Business Mailing Address
First Line	:	11214 SANDSTONE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-2902
Country	:	US
Telephone Number	:	281-736-8411
Fax Number	:	713-270-6413

Provider Business Practice Location Address
First Line	:	11214 SANDSTONE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-2902
Country	:	US
Telephone Number	:	281-736-8411
Fax Number	:	713-270-6413

Authorized Official
Title or Position	:	CEO
Name	:	MRS. MAUREEN SADIQ
Credential	:
Telephone Number	:	281-736-8411

Provider Enumeration Date	:	10/03/2011
Last Update Date	:	10/03/2011

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