MEDICARE: MRS. JOYCE ANN ADESINA

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1528242534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOYCE ANN ADESINA

Provider Business Mailing Address
First Line	:	16730 SPRING BARKER DR
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77429-6934
Country	:	US
Telephone Number	:	713-503-4869
Fax Number	:	281-746-2413

Provider Business Practice Location Address
First Line	:	16730 SPRING BARKER DR
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77429-6934
Country	:	US
Telephone Number	:	713-503-4869
Fax Number	:	281-746-2413

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

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	02/03/2013

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