MEDICARE: JAYCEE'S CHILDREN CENTER, 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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	537260	TX

General Provider Information

NPI Number	:	1679730485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAYCEE'S CHILDREN CENTER, INC.

Provider Business Mailing Address
First Line	:	2902 MILROY LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-4610
Country	:	US
Telephone Number	:	281-440-5077
Fax Number	:	281-440-5099

Provider Business Practice Location Address
First Line	:	2902 MILROY LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-4610
Country	:	US
Telephone Number	:	281-440-5077
Fax Number	:	281-440-5099

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. EURADELL MUCKELROY
Credential	:	LCCA
Telephone Number	:	281-440-5077

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	05/20/2008

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