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Organization subpart
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Provider details

NPI number
Authorized official
MRS. DEANDRA JOHNSON-EGESI RN (PROGRAM MANAGER)
(832) 785-4089
Entity
Organization

Contact information

Practice address
19126 MOSSY HEDGE LN, KATY, TX 77449-4133
(832) 785-4089
Mailing address
19126 MOSSY HEDGE LN, KATY, TX 77449-4133
(832) 785-4089

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
163WA2000X
Administrator Registered Nurse
171M00000X
Case Manager/Care Coordinator
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
364SL0600X
Long-Term Care Clinical Nurse Specialist

Other

Enumeration date
06/10/2024
Last updated
06/19/2024
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