MEDICARE: LIFE ADULT DAYCARE PROGRAM

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	305R00000X	Preferred Provider Organization		TX
2	343900000X	Non-emergency Medical Transport (VAN)	01-0926505	TX

General Provider Information

NPI Number	:	1184951063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE ADULT DAYCARE PROGRAM

Provider Business Mailing Address
First Line	:	8514 C E KING PKWY
Second Line	:	SUITE G
City	:	HOUSTON
State	:	TX
Zip	:	77044-2344
Country	:	US
Telephone Number	:	832-435-0080
Fax Number	:

Provider Business Practice Location Address
First Line	:	8514 C E KING PKWY
Second Line	:	SUITE G
City	:	HOUSTON
State	:	TX
Zip	:	77044-2344
Country	:	US
Telephone Number	:	832-435-0080
Fax Number	:

Authorized Official
Title or Position	:	CHIEF ADMINISTRATOR
Name	:	MR. KHARI RAHSHON SINGLETON
Credential	:
Telephone Number	:	832-435-0080

Provider Enumeration Date	:	11/12/2009
Last Update Date	:	07/21/2022

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Directions to “LIFE ADULT DAYCARE PROGRAM ” Practice Location

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