Healthcare Provider Details

I. General information

NPI: 1487675823
Provider Name (Legal Business Name): VITA-LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 S GESSNER RD SUITE # 150
HOUSTON TX
77063-5100
US

IV. Provider business mailing address

3300 S GESSNER RD SUITE # 150
HOUSTON TX
77063-5100
US

V. Phone/Fax

Practice location:
  • Phone: 713-271-5795
  • Fax: 713-981-4512
Mailing address:
  • Phone: 713-271-5795
  • Fax: 713-981-4512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number001015832
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number000385901
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number000368401
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number000389501
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number760037167
License Number StateTX
# 6
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number000600500
License Number StateTX

VIII. Authorized Official

Name: MR. DAVID LEATHAM
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW-AP
Phone: 713-292-1806