MEDICARE: EXTENDED AFTERCARE, 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	324500000X	Substance Abuse Rehabilitation Facility	593	TX

General Provider Information

NPI Number	:	1992920961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXTENDED AFTERCARE, INC.

Provider Business Mailing Address
First Line	:	5002 N SHEPHERD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-1625
Country	:	US
Telephone Number	:	713-695-8403
Fax Number	:	713-695-3439

Provider Business Practice Location Address
First Line	:	5002 N SHEPHERD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-1625
Country	:	US
Telephone Number	:	713-695-8403
Fax Number	:	713-695-3439

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER
Name	:	MR. STEVEN MICHAEL BOON
Credential	:
Telephone Number	:	713-695-8403

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	08/22/2020

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