MEDICARE: MCR HOME SWEET HOME LLC

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	:	1134675598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCR HOME SWEET HOME LLC

Provider Business Mailing Address
First Line	:	7725 PARDEE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77028-5235
Country	:	US
Telephone Number	:	281-204-7459
Fax Number	:

Provider Business Practice Location Address
First Line	:	7725 PARDEE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77028-5235
Country	:	US
Telephone Number	:	281-204-7459
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JASMINE R CARTER
Credential	:
Telephone Number	:	281-204-7459

Provider Enumeration Date	:	08/26/2016
Last Update Date	:	08/26/2016

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