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General NPI Number Information
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NPI Number | 1740131457
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Entity Type | Organization
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Legal Business Name | 2ND HOME RESIDENTIAL AND SUPPORT LLC
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Dates
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Enumeration Date | 02/07/2026
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 19126 MOSSY HEDGE LN
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City | KATY
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State | TX
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Zip | 77449-4133
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Country | US
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Telephone | 832-408-0556
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Fax | 281-713-5445
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Provider Business Mailing Address
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Address Line | 19126 MOSSY HEDGE LN
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City | KATY
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State | TX
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Zip | 77449-4133
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Country | US
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Telephone | 832-408-0556
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Fax | 281-713-5445
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | DEANDRA JOHNSON-EGESI
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Credential | RN
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Telephone | 832-785-4089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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