MEDICARE: MS. SHARON L GREEN

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	310400000X	Assisted Living Facility
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1295002947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON L GREEN

Provider Business Mailing Address
First Line	:	11800 CITY PARK CENTRAL LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-3242
Country	:	US
Telephone Number	:	832-216-6932
Fax Number	:

Provider Business Practice Location Address
First Line	:	11800 CITY PARK CENTRAL LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-3242
Country	:	US
Telephone Number	:	832-216-6932
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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