MEDICARE: A LITTLE SANCTUARY, 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
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1629731641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A LITTLE SANCTUARY, INC.

Provider Business Mailing Address
First Line	:	3530 GREEN CREST DR APT 723
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-4172
Country	:	US
Telephone Number	:	832-396-4088
Fax Number	:

Provider Business Practice Location Address
First Line	:	3530 GREEN CREST DR APT 723
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-4172
Country	:	US
Telephone Number	:	832-396-4088
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CASE MANAGER
Name	:	VALENCIA LINTON
Credential	:
Telephone Number	:	832-396-4088

Provider Enumeration Date	:	10/17/2021
Last Update Date	:	10/17/2021

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