Healthcare Provider Details

I. General information

NPI: 1881429751
Provider Name (Legal Business Name): HOUSTON HOUSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10445 S KILBOURN AVE
OAK LAWN IL
60453-4844
US

IV. Provider business mailing address

10445 S KILBOURN AVE
OAK LAWN IL
60453-4844
US

V. Phone/Fax

Practice location:
  • Phone: 773-885-7310
  • Fax:
Mailing address:
  • Phone: 773-885-7310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: KELVIN HOUSTON JR.
Title or Position: CEO
Credential:
Phone: 773-885-7310