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General NPI Number Information
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NPI Number | 1104136779
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Entity Type | Organization
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Legal Business Name | GRANNYS HOMES FOR BOYS AND GIRLS RESIDENTIAL TREATMENT CENTER
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 4631 ORKNEY DR.
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City | MISSOURI CITY
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State | TX
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Zip | 77459-2807
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Country | US
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Telephone | 281-499-3322
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Fax | 281-261-2579
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Provider Business Mailing Address
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Address Line | 4631 ORKNEY DR.
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City | MISSOURI CITY
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State | TX
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Zip | 77459-2807
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Country | US
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Telephone | 281-499-3322
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Fax | 281-261-2579
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Authorized Official
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Title or Position | CEO
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Name | MS. LILLIAN M. FISHER
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Credential |
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Telephone | 281-499-3322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | TX
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