# DOMAIN LIVING CENTERS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295252625
- **Authorized official:** ANITA GATES (C.E.O.)
- **Authorized official phone:** (832) 267-6192

## Contact information

- **Practice address:** 9800 BRABURN GLEN BLVD \# 326, HOUSTON, TX 77074
- **Practice address phone:** (832) 267-6192
- **Mailing address:** 9800 BRAEBURN GLEN BLVD APT 326, HOUSTON, TX 77074-2312
- **Mailing address phone:** (832) 267-6192

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | — |
| 171M00000X | Case Manager/Care Coordinator | — | — | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |
| 385HR2060X | Child Intellectual and/or Developmental Disabilities Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 08/25/2017
- **Last updated:** 07/21/2022