MEDICARE: SARAI ELIZABETH OSORIO DE GIBBS

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		TX

General Provider Information

NPI Number	:	1982867289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAI ELIZABETH OSORIO DE GIBBS

Provider Business Mailing Address
First Line	:	6161 SAVOY DR STE 1150
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3323
Country	:	US
Telephone Number	:	713-489-8073
Fax Number	:	832-553-2535

Provider Business Practice Location Address
First Line	:	6161 SAVOY DR STE 1150
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3323
Country	:	US
Telephone Number	:	713-489-8073
Fax Number	:	832-553-2535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	04/13/2022

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