MEDICARE: LIFELONG CONNECTIONS

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	251C00000X	Developmentally Disabled Services Day Training Agency
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care

General Provider Information

NPI Number	:	1588327647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELONG CONNECTIONS

Provider Business Mailing Address
First Line	:	10819 SUMMER MEADOWS CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-4047
Country	:	US
Telephone Number	:	832-274-1710
Fax Number	:

Provider Business Practice Location Address
First Line	:	10819 SUMMER MEADOWS CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-4047
Country	:	US
Telephone Number	:	832-274-1710
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRENDA AMOS
Credential	:
Telephone Number	:	832-274-1710

Provider Enumeration Date	:	10/15/2021
Last Update Date	:	10/19/2021

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Directions to “LIFELONG CONNECTIONS ” Practice Location

Language	Start Address	Practice Location

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