MEDICARE: NEW DIMENSIONS DAY HOSPITAL

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	283Q00000X	Psychiatric Hospital	730-A	TX

General Provider Information

NPI Number	:	1851406169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW DIMENSIONS DAY HOSPITAL

Provider Business Mailing Address
First Line	:	1345 SPACE PARK DR STE C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3469
Country	:	US
Telephone Number	:	281-333-2284
Fax Number	:	281-333-0221

Provider Business Practice Location Address
First Line	:	1345 SPACE PARK DR STE C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3469
Country	:	US
Telephone Number	:	281-333-2284
Fax Number	:	281-333-0221

Authorized Official
Title or Position	:	CEO
Name	:	MR. GEORGE RANDALL BRAZZEL
Credential	:	MA, LPC, LMFT
Telephone Number	:	281-333-2284

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/01/2008

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