MEDICARE: MS. FLORENCE N BENNETT

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	311ZA0620X	Adult Care Home Facility		TX
3	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	86H	TX
4	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
5	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	COMPONENT CODE86H	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700965167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. FLORENCE N BENNETT

Provider Business Mailing Address
First Line	:	PO BOX 300079
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77230-0079
Country	:	US
Telephone Number	:	713-303-1325
Fax Number	:	713-520-7623

Provider Business Practice Location Address
First Line	:	11122 COLEBROOK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-1922
Country	:	US
Telephone Number	:	713-667-8307
Fax Number	:	713-520-7623

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2006
Last Update Date	:	05/09/2019

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