MEDICARE: PUGH WEE LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588527337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUGH WEE LLC

Provider Business Mailing Address
First Line	:	5500 CHINA BERRY RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78744-4048
Country	:	US
Telephone Number	:	832-830-2110
Fax Number	:

Provider Business Practice Location Address
First Line	:	16302 N MIST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77073-5302
Country	:	US
Telephone Number	:	832-830-2110
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KAMREA JOHNSON
Credential	:
Telephone Number	:	832-830-2110

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “PUGH WEE LLC ” Practice Location

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