MEDICARE: PEPPERTREE COMPLETE 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	261QD1600X	Developmental Disabilities Clinic/Center
2	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
4	251E00000X	Home Health Agency
5	251S00000X	Community/Behavioral Health Agency
6	261QC1500X	Community Health Clinic/Center
7	251B00000X	Case Management Agency	1016629	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001008749	OTHER	TX	TX HHSC LONGTERM CARE CONTRACT NUMBER

General Provider Information

NPI Number	:	1790938025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEPPERTREE COMPLETE CARE, LLC

Provider Business Mailing Address
First Line	:	2600 S LOOP W STE 448
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2606
Country	:	US
Telephone Number	:	832-900-2384
Fax Number	:	888-259-5108

Provider Business Practice Location Address
First Line	:	11818 LONGWOOD GARDEN WAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-4434
Country	:	US
Telephone Number	:	832-900-2384
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KINA JEFFERSON
Credential	:
Telephone Number	:	832-527-6750

Provider Enumeration Date	:	10/30/2008
Last Update Date	:	12/11/2023

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Directions to “PEPPERTREE COMPLETE CARE, LLC ” Practice Location

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