MEDICARE: A-TARK, 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1669739249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A-TARK, INC

Provider Business Mailing Address
First Line	:	12662 REDBUD VILLA LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77086-3181
Country	:	US
Telephone Number	:	832-434-1230
Fax Number	:	713-633-4243

Provider Business Practice Location Address
First Line	:	12662 REDBUD VILLA LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77086-3181
Country	:	US
Telephone Number	:	832-434-1230
Fax Number	:	713-633-4243

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MR. DEAUNSEY ALEXANDER
Credential	:
Telephone Number	:	832-434-1230

Provider Enumeration Date	:	04/19/2012
Last Update Date	:	04/19/2012

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