Organization
THAT 1 HOME
Active
Organization
THAT 1 HOME
Active
Organization subpart
No
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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