MEDICARE: ADDICTS CAN BE DISCIPLES TOO

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	302F00000X	Exclusive Provider Organization

General Provider Information

NPI Number	:	1588902035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDICTS CAN BE DISCIPLES TOO

Provider Business Mailing Address
First Line	:	3711 SOUTHMORE BLVD APT 1115
Second Line	:	1415CUSHING ST
City	:	HOUSTON
State	:	TX
Zip	:	77004-7948
Country	:	US
Telephone Number	:	713-659-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3711 SOUTHMORE BLVD APT 1115
Second Line	:	1415CUSHING ST
City	:	HOUSTON
State	:	TX
Zip	:	77004-7948
Country	:	US
Telephone Number	:	713-659-7700
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. SHIRLEY R PALMER
Credential	:	CERTIFIED FAITH-BASE
Telephone Number	:	713-529-2840

Provider Enumeration Date	:	01/17/2013
Last Update Date	:	01/17/2013

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