MEDICARE: EXPERT LIVING SERVICES INC

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1073098075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPERT LIVING SERVICES INC

Provider Business Mailing Address
First Line	:	17014 BLUE MIST DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77498-1957
Country	:	US
Telephone Number	:	832-867-8447
Fax Number	:	281-670-5042

Provider Business Practice Location Address
First Line	:	17014 BLUE MIST DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77498-1957
Country	:	US
Telephone Number	:	832-867-8447
Fax Number	:	281-670-5042

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CHIMDIKE VICTOR OGBONNAYA
Credential	:
Telephone Number	:	832-867-8447

Provider Enumeration Date	:	09/26/2018
Last Update Date	:	09/26/2018

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