MEDICARE: DSR HEALTH MANAGEMENT INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
3	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1093276875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DSR HEALTH MANAGEMENT INC

Provider Business Mailing Address
First Line	:	23411 STARBRIDGE LAKE LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2881
Country	:	US
Telephone Number	:	832-277-3228
Fax Number	:

Provider Business Practice Location Address
First Line	:	23411 STARBRIDGE LAKE LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2881
Country	:	US
Telephone Number	:	832-277-3228
Fax Number	:

Authorized Official
Title or Position	:	C.E.O.
Name	:	SYMPHOROSA GODFREY
Credential	:
Telephone Number	:	832-277-3228

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	03/26/2019

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