MEDICARE: SH DETOX HOUSTON, 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	324500000X	Substance Abuse Rehabilitation Facility		FL

General Provider Information

NPI Number	:	1487191235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SH DETOX HOUSTON, LLC

Provider Business Mailing Address
First Line	:	PO BOX 2070
Second Line	:
City	:	HALLANDALE
State	:	FL
Zip	:	33008-2070
Country	:	US
Telephone Number	:	954-336-7747
Fax Number	:	954-212-2328

Provider Business Practice Location Address
First Line	:	9714 S GESSNER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-1004
Country	:	US
Telephone Number	:	832-240-3024
Fax Number	:	954-212-2328

Authorized Official
Title or Position	:	DIRECTOR OF LCC
Name	:	STACEY BUTLER
Credential	:
Telephone Number	:	410-807-8471

Provider Enumeration Date	:	01/31/2017
Last Update Date	:	02/14/2022

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Directions to “SH DETOX HOUSTON, LLC ” Practice Location

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