MEDICARE: SPECIAL TEXAS HOMES, INC.

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	116305	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45H023	OTHER		TEXAS

General Provider Information

NPI Number	:	1467460485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIAL TEXAS HOMES, INC.

Provider Business Mailing Address
First Line	:	4115 GALVESTON RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77017-2518
Country	:	US
Telephone Number	:	713-475-2228
Fax Number	:	713-475-2332

Provider Business Practice Location Address
First Line	:	5126 BOSWORTH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77017-4002
Country	:	US
Telephone Number	:	713-649-4340
Fax Number	:	713-475-2332

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. JERRINE B HARRELL
Credential	:
Telephone Number	:	318-445-6470

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	08/22/2020

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Directions to “SPECIAL TEXAS HOMES, INC. ” Practice Location

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