MEDICARE: WELCOME HOUSE, 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	251S00000X	Community/Behavioral Health Agency	5700	TX

General Provider Information

NPI Number	:	1679874929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELCOME HOUSE, INC.

Provider Business Mailing Address
First Line	:	4202 S LANCASTER RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75216-6459
Country	:	US
Telephone Number	:	214-421-3948
Fax Number	:	214-421-1705

Provider Business Practice Location Address
First Line	:	4202 S LANCASTER RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75216-6459
Country	:	US
Telephone Number	:	214-421-3948
Fax Number	:	214-421-1705

Authorized Official
Title or Position	:	ASSOCIATE DIRECTOR
Name	:	L. DIANE EVANS
Credential	:
Telephone Number	:	214-421-3948

Provider Enumeration Date	:	11/03/2010
Last Update Date	:	11/03/2010

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