MEDICARE: ST. CYPRAIN'S HEALTH 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1518104298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. CYPRAIN'S HEALTH INC.

Provider Business Mailing Address
First Line	:	PO BOX 1564
Second Line	:
City	:	BELLAIRE
State	:	TX
Zip	:	77402-1564
Country	:	US
Telephone Number	:	713-271-2611
Fax Number	:	713-271-2651

Provider Business Practice Location Address
First Line	:	6633 HILLCROFT ST
Second Line	:	SUITE 133
City	:	HOUSTON
State	:	TX
Zip	:	77081-4887
Country	:	US
Telephone Number	:	713-271-2611
Fax Number	:	713-271-2651

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MARSHAL OKECHUKWU NDUKWE
Credential	:
Telephone Number	:	832-473-9771

Provider Enumeration Date	:	01/16/2009
Last Update Date	:	03/15/2012

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