Healthcare Provider Details

I. General information

NPI: 1174209571
Provider Name (Legal Business Name): SANTA MARIA HOSTEL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 12/05/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 PARKER ROAD
HOUSTON TX
77093
US

IV. Provider business mailing address

2605 PARKER ROAD
HOUSTON TX
77093
US

V. Phone/Fax

Practice location:
  • Phone: 713-301-2618
  • Fax: 713-691-0910
Mailing address:
  • Phone: 713-301-2618
  • Fax: 713-691-0910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BARBARA M PAGE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 713-301-2618