MEDICARE: SHAMAR HOPE HAVEN RESIDENTIAL TREATMENT CENTER

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	3245S0500X	Children's Substance Abuse Rehabilitation Facility	838067	TX
2	3245S0500X	Children's Substance Abuse Rehabilitation Facility	2099A	TX

General Provider Information

NPI Number	:	1225362338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAMAR HOPE HAVEN RESIDENTIAL TREATMENT CENTER

Provider Business Mailing Address
First Line	:	2719 TRUXILLO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-5455
Country	:	US
Telephone Number	:	713-942-8822
Fax Number	:

Provider Business Practice Location Address
First Line	:	2719 TRUXILLO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-5455
Country	:	US
Telephone Number	:	713-942-8822
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. SHARON ANN EVANS
Credential	:	LCCA
Telephone Number	:	713-942-8822

Provider Enumeration Date	:	09/22/2009
Last Update Date	:	09/22/2009

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