MEDICARE: SULLIVAN HELP CENTER CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	253J00000X	Foster Care Agency
3	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
4	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
5	324500000X	Substance Abuse Rehabilitation Facility
6	372600000X	Adult Companion
7	376J00000X	Homemaker
8	385H00000X	Respite Care
9	385HR2050X	Respite Care Camp
10	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1366758062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SULLIVAN HELP CENTER CORPORATION

Provider Business Mailing Address
First Line	:	13985 BROKEN ARROW DR
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378-4323
Country	:	US
Telephone Number	:	936-856-6136
Fax Number	:	936-856-7549

Provider Business Practice Location Address
First Line	:	15710 BOND LN
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77303-4183
Country	:	US
Telephone Number	:	832-549-1364
Fax Number	:	855-693-4662

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	MRS. TANITA SHANTA SULLIVAN
Credential	:
Telephone Number	:	936-856-6136

Provider Enumeration Date	:	08/19/2010
Last Update Date	:	03/12/2021

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