MEDICARE: BAY ALLEN SOCIAL SERVICES

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	305S00000X	Point of Service

General Provider Information

NPI Number	:	1982824637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY ALLEN SOCIAL SERVICES

Provider Business Mailing Address
First Line	:	2690 HOLLY HALL ST
Second Line	:	APT A
City	:	HOUSTON
State	:	TX
Zip	:	77054-4210
Country	:	US
Telephone Number	:	832-439-2174
Fax Number	:	281-974-3402

Provider Business Practice Location Address
First Line	:	2690 HOLLY HALL ST
Second Line	:	APT A
City	:	HOUSTON
State	:	TX
Zip	:	77054-4210
Country	:	US
Telephone Number	:	832-439-2174
Fax Number	:	281-974-3402

Authorized Official
Title or Position	:	OWNER
Name	:	MR. FITZHERBERT HENDERSON LEGALL
Credential	:
Telephone Number	:	832-439-2174

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/09/2008

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