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NPI Code Detail

MEDICARE: BRENDA DICKENS HOUSE OF PEACE

MEDICARE: BRENDA DICKENS HOUSE OF PEACE
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
1385HR2060XChild Intellectual and/or Developmental Disabilities Respite Care
23104A0625XAssisted Living Facility (Mental Illness)

General Provider Information

NPI Number : 1174012900
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRENDA DICKENS HOUSE OF PEACE
Provider Business Mailing Address
First Line : 6619 INDIAN FALLS DR
Second Line :
City : MISSOURI CITY
State : TX
Zip : 77489-2633
Country : US
Telephone Number : 281-438-8166
Fax Number : 346-888-5285
Provider Business Practice Location Address
First Line : 6619 INDIAN FALLS DR
Second Line :
City : MISSOURI CITY
State : TX
Zip : 77489-2633
Country : US
Telephone Number : 281-438-8166
Fax Number : 346-888-5285
Authorized Official
Title or Position : OWNER
Name : BRENDA DICKENS
Credential :
Telephone Number : 281-438-8166
Provider Enumeration Date : 05/07/2018
Last Update Date : 05/07/2018

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Directions to “BRENDA DICKENS HOUSE OF PEACE ” Practice Location

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