MEDICARE: DISCOVERY COMMUNITY OF HOUSTON

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	324500000X	Substance Abuse Rehabilitation Facility	3671-3672	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3471-3472	OTHER	TX	TEXAS DEPT OF STATE HEALTH SERVICES REGULATORY LICENSING UNIT

General Provider Information

NPI Number	:	1720416852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISCOVERY COMMUNITY OF HOUSTON

Provider Business Mailing Address
First Line	:	2330 CAMDEN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77021-1010
Country	:	US
Telephone Number	:	832-543-3472
Fax Number	:	713-774-0631

Provider Business Practice Location Address
First Line	:	6714 TAM O SHANTER LN
Second Line	:	5903 REDDING RD
City	:	HOUSTON
State	:	TX
Zip	:	77036-4948
Country	:	US
Telephone Number	:	832-543-3472
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LAWRENCE CHAN
Credential	:
Telephone Number	:	832-217-8645

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	11/01/2013

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Directions to “DISCOVERY COMMUNITY OF HOUSTON ” Practice Location

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