Healthcare Provider Details

I. General information

NPI: 1144433269
Provider Name (Legal Business Name): SOMMERVILLE YOUNG ADULT COMMUNITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 ANTHONY RD
CLEVELAND TX
77328-5497
US

IV. Provider business mailing address

1 SUGAR CREEK CENTER BLVD SUITE 965
SUGAR LAND TX
77478-3560
US

V. Phone/Fax

Practice location:
  • Phone: 281-592-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateTX

VIII. Authorized Official

Name: ANTHONY GERACI
Title or Position: PRESIDENT
Credential:
Phone: 281-313-1908