Organization
CLASSIC GROUP H OME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHIRLEY ANN SHAW (OWNER)
(281) 452-4661
Entity
Organization
Contact information
Practice address
1454 SOMERCOTES LN, CHANNELVIEW, TX 77530-2258
(281) 452-4661
(281) 452-4639
Mailing address
1454 SOMERCOTES LN, CHANNELVIEW, TX 77530-2258
(281) 452-4661
(281) 452-4639
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
115384
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000756001
PROVIDER NUMBER
TX
Enumeration date
10/24/2006
Last updated
07/16/2013
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