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NPI Code Detail

MEDICARE: EXPANDING BEAUTIFUL MINDS LLC

MEDICARE: EXPANDING BEAUTIFUL MINDS 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
1385HR2060XChild Intellectual and/or Developmental Disabilities Respite Care
2322D00000XEmotionally Disturbed Childrens' Residential Treatment Facility
3320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1760836084
Entity Type Code : Organization
Provider Name (Legal Business Name) : EXPANDING BEAUTIFUL MINDS LLC
Provider Business Mailing Address
First Line : 9723 HOMESTEAD RD
Second Line :
City : HOUSTON
State : TX
Zip : 77016-4403
Country : US
Telephone Number : 832-506-8121
Fax Number : 180-091-8697
Provider Business Practice Location Address
First Line : 9723 HOMESTEAD RD
Second Line :
City : HOUSTON
State : TX
Zip : 77016-4403
Country : US
Telephone Number : 832-506-8121
Fax Number : 180-091-8697
Authorized Official
Title or Position : CEO
Name : D0RA E VILLEGAS
Credential :
Telephone Number : 832-506-8121
Provider Enumeration Date : 04/22/2016
Last Update Date : 04/28/2016

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Directions to “EXPANDING BEAUTIFUL MINDS LLC ” Practice Location

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