MEDICARE: VISIONARY COMMUNITY HEALTHCARE CENTER, 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

General Provider Information

NPI Number	:	1205169554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISIONARY COMMUNITY HEALTHCARE CENTER, LLC

Provider Business Mailing Address
First Line	:	5103 LANGLEY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-2917
Country	:	US
Telephone Number	:	713-633-7444
Fax Number	:	713-633-7444

Provider Business Practice Location Address
First Line	:	5103 LANGLEY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-2917
Country	:	US
Telephone Number	:	713-633-7444
Fax Number	:	713-633-7444

Authorized Official
Title or Position	:	OWNER
Name	:	MS. GWENDOLYN KAY FRANK
Credential	:
Telephone Number	:	832-665-8218

Provider Enumeration Date	:	09/17/2009
Last Update Date	:	02/24/2010

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