MEDICARE: ALL FOR YOUTH REHAB. CTR. INC.

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	101Y00000X	Counselor	19337	TX
2	101Y00000X	Counselor	20306	TX
3	163W00000X	Registered Nurse	227177	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942465372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL FOR YOUTH REHAB. CTR. INC.

Provider Business Mailing Address
First Line	:	7100 REGENCY SQUARE SQ
Second Line	:	STE 103B
City	:	HOUSTON
State	:	TX
Zip	:	77036-5807
Country	:	US
Telephone Number	:	713-866-6505
Fax Number	:

Provider Business Practice Location Address
First Line	:	7100 REGENCY SQ STE
Second Line	:	103B
City	:	HOUSTON
State	:	TX
Zip	:	77036-5807
Country	:	US
Telephone Number	:	713-866-6505
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. SHELDON MURRAY
Credential	:
Telephone Number	:	713-866-6505

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	10/21/2008

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