MEDICARE: VERIZON HEALTH RESOURCES 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1942571740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERIZON HEALTH RESOURCES LLC

Provider Business Mailing Address
First Line	:	5202 EMORY MILL RD
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-7120
Country	:	US
Telephone Number	:	832-595-1733
Fax Number	:	832-595-1760

Provider Business Practice Location Address
First Line	:	5202 EMORY MILL RD
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-7120
Country	:	US
Telephone Number	:	832-595-1733
Fax Number	:	832-595-1760

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JORFUI DOLLY KANDEH-DABO
Credential	:	RN
Telephone Number	:	832-595-1733

Provider Enumeration Date	:	01/25/2012
Last Update Date	:	01/25/2012

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Directions to “VERIZON HEALTH RESOURCES LLC ” Practice Location

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