MEDICARE: RCJ HEALTHCARE SERVICES 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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1548511678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RCJ HEALTHCARE SERVICES INC

Provider Business Mailing Address
First Line	:	12502 RIVA RIDGE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-3223
Country	:	US
Telephone Number	:	712-252-5828
Fax Number	:

Provider Business Practice Location Address
First Line	:	12502 RIVA RIDGE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-3223
Country	:	US
Telephone Number	:	712-252-5828
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. ROSE EGBON
Credential	:
Telephone Number	:	713-252-5828

Provider Enumeration Date	:	09/28/2012
Last Update Date	:	09/28/2012

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