MEDICARE: HEAL RITE WELLNESS COMMUNITY MENTAL HEALTH CARE CENTRE, 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	1041C0700X	Clinical Social Worker
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1275975765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAL RITE WELLNESS COMMUNITY MENTAL HEALTH CARE CENTRE, LLC

Provider Business Mailing Address
First Line	:	8822 CHACO HILL LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-5021
Country	:	US
Telephone Number	:	832-373-6316
Fax Number	:

Provider Business Practice Location Address
First Line	:	5103 LANGLEY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-2917
Country	:	US
Telephone Number	:	832-373-6316
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	PATRICK IYOBOSA OSEMWENGIE
Credential	:
Telephone Number	:	832-373-6316

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	07/26/2013

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