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General NPI Number Information
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NPI Number | 1114422813
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Entity Type | Organization
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Legal Business Name | JULIAN'S HOUSE LLC
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 16711 JELLY PARK STONE DR
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City | CYPRESS
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State | TX
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Zip | 77429-6024
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Country | US
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Telephone | 281-746-2389
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Fax |
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Provider Business Mailing Address
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Address Line | 17535 DRIFTWOOD PRAIRIE LN
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City | HOUSTON
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State | TX
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Zip | 77095-5122
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Country | US
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Telephone | 281-746-2389
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | INGRID CRAWFORD
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Credential |
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Telephone | 704-297-8286
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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 |
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