MEDICARE: DIXON HOME AND COMMUNITY SERVICES 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	311Z00000X	Custodial Care Facility

General Provider Information

NPI Number	:	1902354905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIXON HOME AND COMMUNITY SERVICES LLC

Provider Business Mailing Address
First Line	:	6422 GLADEHILL DR
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77345-2526
Country	:	US
Telephone Number	:	210-310-9722
Fax Number	:

Provider Business Practice Location Address
First Line	:	6422 GLADEHILL DR
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77345-2526
Country	:	US
Telephone Number	:	210-310-9722
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. DEVON M DIXON
Credential	:
Telephone Number	:	210-310-9722

Provider Enumeration Date	:	09/19/2016
Last Update Date	:	09/19/2016

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