MEDICARE: DAISY DAYCARE AND COMMUNITY OUTREACH CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	171W00000X	Contractor
3	172A00000X	Driver
4	174200000X	Meals Provider
5	251300000X	Local Education Agency (LEA)
6	251C00000X	Developmentally Disabled Services Day Training Agency
7	251S00000X	Community/Behavioral Health Agency
8	261QD1600X	Developmental Disabilities Clinic/Center
9	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
10	343900000X	Non-emergency Medical Transport (VAN)
11	347B00000X	Bus
12	347C00000X	Private Vehicle
13	385H00000X	Respite Care
14	261QA0600X	Adult Day Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619677291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAISY DAYCARE AND COMMUNITY OUTREACH CENTER, LLC

Provider Business Mailing Address
First Line	:	7312 LOUETTA RD APT 157
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-6175
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7312 LOUETTA RD APT 157
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-6175
Country	:	US
Telephone Number	:	832-855-1656
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	KIMBERLY JEFFERY
Credential	:
Telephone Number	:	832-855-1656

Provider Enumeration Date	:	03/03/2023
Last Update Date	:	03/03/2023

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