MEDICARE: AMANUEL D ATSBAHA

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1144405812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMANUEL D ATSBAHA

Provider Business Mailing Address
First Line	:	7400BELLERIVE APT.1303
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036
Country	:	US
Telephone Number	:	281-704-8495
Fax Number	:	713-974-6653

Provider Business Practice Location Address
First Line	:	7400 BELLERIVE DR APT 1303
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3048
Country	:	US
Telephone Number	:	281-704-8495
Fax Number	:	713-974-6653

Authorized Official
Title or Position	:	CEO
Name	:	MR. AMANUEL DEBESAY ATSBAHA
Credential	:
Telephone Number	:	281-704-8495

Provider Enumeration Date	:	12/31/2007
Last Update Date	:	12/31/2007

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