Healthcare Provider Details

I. General information

NPI: 1235605494
Provider Name (Legal Business Name): HAL'S HOME & RESIDENTIAL CARE COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12514 BERRY LAUREL LN
HOUSTON TX
77014-2445
US

IV. Provider business mailing address

12514 BERRY LAUREL LN
HOUSTON TX
77014-2445
US

V. Phone/Fax

Practice location:
  • Phone: 832-596-9931
  • Fax: 832-286-1769
Mailing address:
  • Phone: 832-596-9931
  • Fax: 832-286-1769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SHARION LENESE WHITE
Title or Position: CFO/CEO
Credential:
Phone: 832-596-9934