=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033107826
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTRACARE HOSPITAL NORTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2005
-----------------------------------------------------
Last Update Date | 10/23/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1120 CYPRESS STATION DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77090-3002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-893-7200
-----------------------------------------------------
Fax | 281-583-0137
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1120 CYPRESS STATION DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77090-3002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-893-7200
-----------------------------------------------------
Fax | 281-583-0137
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO, HEALTHCARE OPERATIONS
-----------------------------------------------------
Name | MR. TERRY SCOVILL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-893-7200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283Q00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital
-----------------------------------------------------
License Number | 782
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------