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General NPI Number Information
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NPI Number | 1063624237
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Entity Type | Organization
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Legal Business Name | S & G COMMUNITY LIVING CENTER, INC.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/10/2007
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Provider Practice Location Address
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Address Line | 7865 PECAN VILLAS
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City | HOUSTON
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State | TX
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Zip | 77061
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Country | US
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Telephone | 713-598-1471
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Fax | 281-334-7850
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Provider Business Mailing Address
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Address Line | P.O. BOX 686
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City | LEAGUE CITY
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State | TX
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Zip | 77574
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Country | US
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Telephone | 713-598-1471
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Fax | 281-334-7850
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEVE ALAN MULKEY
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Credential | QMRP
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Telephone | 713-598-1471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 117286
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License Number State | TX
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