=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447979240
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARE & LEARNING CONNECTION CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2022
-----------------------------------------------------
Last Update Date | 03/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1817 PANNELL ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77020-2336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-443-7517
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1817 PANNELL ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77020-2336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-443-7517
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM MANAGER
-----------------------------------------------------
Name | CYNTHIA DIANE BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-443-7517
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------