MEDICARE: TEXAS RESIDENTIAL & VOCATIONAL SERVICES

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	177F00000X	Lodging Provider	121451	TX

General Provider Information

NPI Number	:	1720263965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS RESIDENTIAL & VOCATIONAL SERVICES

Provider Business Mailing Address
First Line	:	2107 BRUNSWICK DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-2023
Country	:	US
Telephone Number	:	512-928-2498
Fax Number	:	512-928-2473

Provider Business Practice Location Address
First Line	:	2107 BRUNSWICK DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-2023
Country	:	US
Telephone Number	:	512-928-2498
Fax Number	:	512-928-2473

Authorized Official
Title or Position	:	OWNER
Name	:	MR. BENNY RAY HOWARD
Credential	:
Telephone Number	:	512-928-2498

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	07/18/2008

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