MEDICARE: EZ LIVING RESIDENTIAL HOME

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	:	1184979114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EZ LIVING RESIDENTIAL HOME

Provider Business Mailing Address
First Line	:	5823 MOUNT HOUSTON RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77050-5429
Country	:	US
Telephone Number	:	832-230-1769
Fax Number	:	832-230-1769

Provider Business Practice Location Address
First Line	:	5823 MOUNT HOUSTON RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77050-5429
Country	:	US
Telephone Number	:	832-230-1769
Fax Number	:	832-230-1769

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	HATTIE M BANKS
Credential	:
Telephone Number	:	832-230-1769

Provider Enumeration Date	:	07/16/2012
Last Update Date	:	07/16/2012

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Directions to “EZ LIVING RESIDENTIAL HOME ” Practice Location

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