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General NPI Number Information
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NPI Number | 1295252625
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Entity Type | Organization
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Legal Business Name | DOMAIN LIVING CENTERS LLC
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 9800 BRABURN GLEN BLVD # 326
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City | HOUSTON
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State | TX
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Zip | 77074
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Country | US
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Telephone | 832-267-6192
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Fax |
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Provider Business Mailing Address
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Address Line | 9800 BRAEBURN GLEN BLVD APT 326
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City | HOUSTON
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State | TX
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Zip | 77074-2312
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Country | US
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Telephone | 832-267-6192
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Fax |
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Authorized Official
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Title or Position | C.E.O.
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Name | ANITA GATES
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Credential |
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Telephone | 832-267-6192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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