MEDICARE: KARA LIVING CENTERS, 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	101YM0800X	Mental Health Counselor
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1417002346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KARA LIVING CENTERS, INC

Provider Business Mailing Address
First Line	:	3903 HARTSDALE DR
Second Line	:	SUITE 1
City	:	HOUSTON
State	:	TX
Zip	:	77063-6403
Country	:	US
Telephone Number	:	713-933-0045
Fax Number	:	713-933-0047

Provider Business Practice Location Address
First Line	:	3903 HARTSDALE DR
Second Line	:	SUITE 1
City	:	HOUSTON
State	:	TX
Zip	:	77063-6403
Country	:	US
Telephone Number	:	713-933-0045
Fax Number	:	713-933-0047

Authorized Official
Title or Position	:	CEO
Name	:	OLO IZOBO
Credential	:
Telephone Number	:	713-933-0045

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	06/10/2020

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