Organization
DOMAIN LIVING CENTERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANITA GATES (C.E.O.)
(832) 267-6192
Entity
Organization
Contact information
Practice address
9800 BRABURN GLEN BLVD # 326, HOUSTON, TX 77074
(832) 267-6192
Mailing address
9800 BRAEBURN GLEN BLVD APT 326, HOUSTON, TX 77074-2312
(832) 267-6192
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
08/25/2017
Last updated
07/21/2022
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