MEDICARE: REDEEMED HOUSE OF DAVID TRANSITIONAL LIVING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1003119512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDEEMED HOUSE OF DAVID TRANSITIONAL LIVING

Provider Business Mailing Address
First Line	:	1741A JACQUELYN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-3603
Country	:	US
Telephone Number	:	281-736-7014
Fax Number	:	281-855-9776

Provider Business Practice Location Address
First Line	:	1741A JACQUELYN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-3603
Country	:	US
Telephone Number	:	281-736-7014
Fax Number	:	281-855-9776

Authorized Official
Title or Position	:	CEO
Name	:	MR. DAVID JOHNSON
Credential	:
Telephone Number	:	281-736-7014

Provider Enumeration Date	:	12/06/2010
Last Update Date	:	12/06/2010

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Directions to “REDEEMED HOUSE OF DAVID TRANSITIONAL LIVING ” Practice Location

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