MEDICARE: SOMMERVILLE YOUNG ADULT COMMUNITY 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		TX

General Provider Information

NPI Number	:	1144433269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOMMERVILLE YOUNG ADULT COMMUNITY LLC

Provider Business Mailing Address
First Line	:	1 SUGAR CREEK CENTER BLVD
Second Line	:	SUITE 965
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 ANTHONY RD
Second Line	:
City	:	CLEVELAND
State	:	TX
Zip	:	77328-5497
Country	:	US
Telephone Number	:	281-592-4600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTHONY GERACI
Credential	:
Telephone Number	:	281-313-1908

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	08/22/2020

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