MEDICARE: PERKINS ENTERPRISES, 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	251C00000X	Developmentally Disabled Services Day Training Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1629278684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERKINS ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 751562
Second Line	:	10570 FUQUA ST
City	:	HOUSTON
State	:	TX
Zip	:	77275-1562
Country	:	US
Telephone Number	:	832-208-4731
Fax Number	:

Provider Business Practice Location Address
First Line	:	10570 FUQUA ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77089-1402
Country	:	US
Telephone Number	:	832-208-4731
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MS. SANDRA MENEFIELD PERKINS
Credential	:	ADMINISTRATOR
Telephone Number	:	832-208-4731

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	07/18/2007

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