MEDICARE: UNLIMITED VISIONS AFTERCARE, INC

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	1661-B	TX
2	3245S0500X	Children's Substance Abuse Rehabilitation Facility	161-3121	TX
3	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	1661-A	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	161-3121	OTHER	TX	TEXAS DEPARTMENT OF STATE HEALTH SERVICES
2	1661-B	OTHER	TX	TEXAS DEPARTMENT OF STATE HEALTH SERVICES
3	1661-A	OTHER	TX	TEXAS DEPARTMENT OF STATE HEALTH SERVICES

General Provider Information

NPI Number	:	1194047662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNLIMITED VISIONS AFTERCARE, INC

Provider Business Mailing Address
First Line	:	5527 LAWNDALE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-3818
Country	:	US
Telephone Number	:	713-921-2276
Fax Number	:	713-921-7466

Provider Business Practice Location Address
First Line	:	5527 LAWNDALE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-3818
Country	:	US
Telephone Number	:	713-921-2276
Fax Number	:	713-921-7466

Authorized Official
Title or Position	:	MANAGING EXECUTIVEOFFICER
Name	:	REGINA J HASAN
Credential	:	LCDC
Telephone Number	:	713-921-2276

Provider Enumeration Date	:	02/24/2010
Last Update Date	:	02/24/2010

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Directions to “UNLIMITED VISIONS AFTERCARE, INC ” Practice Location

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