Healthcare Provider Details

I. General information

NPI: 1821339607
Provider Name (Legal Business Name): YTONJA'S CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 04/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8203 STAGEWOOD DR
HUMBLE TX
77338-2721
US

IV. Provider business mailing address

PO BOX 2194
HUMBLE TX
77347-2194
US

V. Phone/Fax

Practice location:
  • Phone: 832-588-6294
  • Fax:
Mailing address:
  • Phone: 832-588-6294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. YTONJA LATRICE KEYS
Title or Position: OWNER
Credential:
Phone: 832-588-6294