Healthcare Provider Details

I. General information

NPI: 1962624460
Provider Name (Legal Business Name): CENTER FOR SUCCESS AND INDEPENDENCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 PINEMONT
HOUSTON TX
77018
US

IV. Provider business mailing address

3722 PINEMONT
HOUSTON TX
77018
US

V. Phone/Fax

Practice location:
  • Phone: 713-426-4545
  • Fax: 713-426-4747
Mailing address:
  • Phone: 713-426-4545
  • Fax: 713-426-4747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number844802
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number1930-1930A
License Number StateTX

VIII. Authorized Official

Name: MARYLOU ERBLAND
Title or Position: CLINICAL DIRECTOR
Credential: PH.D.
Phone: 713-426-4545