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NPI Code Detail

MEDICARE: VITA-LIVING, INC.

MEDICARE: VITA-LIVING, 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
1251B00000XCase Management Agency001015832TX
2315P00000XIntellectual Disabilities Intermediate Care Facility000385901TX
3315P00000XIntellectual Disabilities Intermediate Care Facility000368401TX
4315P00000XIntellectual Disabilities Intermediate Care Facility000389501TX
5320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility760037167TX
6251B00000XCase Management Agency000600500TX

General Provider Information

NPI Number : 1487675823
Entity Type Code : Organization
Provider Name (Legal Business Name) : VITA-LIVING, INC.
Provider Business Mailing Address
First Line : 3300 S GESSNER RD
Second Line : SUITE # 150
City : HOUSTON
State : TX
Zip : 77063-5100
Country : US
Telephone Number : 713-271-5795
Fax Number : 713-981-4512
Provider Business Practice Location Address
First Line : 3300 S GESSNER RD
Second Line : SUITE # 150
City : HOUSTON
State : TX
Zip : 77063-5100
Country : US
Telephone Number : 713-271-5795
Fax Number : 713-981-4512
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. DAVID LEATHAM
Credential : MSW-AP
Telephone Number : 713-292-1806
Provider Enumeration Date : 07/21/2006
Last Update Date : 06/18/2008

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Directions to “VITA-LIVING, INC. ” Practice Location

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