MEDICARE: LITTLE HOMES ON ICE 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1689277303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE HOMES ON ICE INC

Provider Business Mailing Address
First Line	:	8802 KETCHWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-1531
Country	:	US
Telephone Number	:	281-912-9957
Fax Number	:

Provider Business Practice Location Address
First Line	:	8802 KETCHWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-1531
Country	:	US
Telephone Number	:	281-912-9957
Fax Number	:

Authorized Official
Title or Position	:	C.E.O
Name	:	DALA EWEKA
Credential	:
Telephone Number	:	281-912-9957

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	04/14/2026

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