Healthcare Provider Details

I. General information

NPI: 1720073760
Provider Name (Legal Business Name): MERIDIAN LIVING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9894 BISSONNET ST SUITE 1604
HOUSTON TX
77036-8239
US

IV. Provider business mailing address

9894 BISSONNET ST SUITE 1604
HOUSTON TX
77036-8239
US

V. Phone/Fax

Practice location:
  • Phone: 713-979-9040
  • Fax: 713-995-8171
Mailing address:
  • Phone: 713-979-9040
  • Fax: 713-995-8171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number723901
License Number StateTX

VIII. Authorized Official

Name: MR. LINER O ANEKWE
Title or Position: ADMINISTRATOR
Credential:
Phone: 713-979-9040