MEDICARE: EPIC CARE LLC

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	:	1699199844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EPIC CARE LLC

Provider Business Mailing Address
First Line	:	606 N ELDER GROVE DR
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7790
Country	:	US
Telephone Number	:	832-206-2681
Fax Number	:	832-328-7458

Provider Business Practice Location Address
First Line	:	606 N ELDER GROVE DR
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7790
Country	:	US
Telephone Number	:	832-206-2681
Fax Number	:	832-328-7458

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	ESTHER AVWORO
Credential	:
Telephone Number	:	832-206-2681

Provider Enumeration Date	:	02/08/2014
Last Update Date	:	02/08/2014

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Directions to “EPIC CARE LLC ” Practice Location

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