Organization
LIBERTY ISLAND PERSONAL CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES EDWARD JOHNSON (DIRECTOR OF OPERATIONS)
(281) 530-0000
Entity
Organization
Contact information
Practice address
9009 BOONE RD, HOUSTON, TX 77099-2033
(281) 530-0000
(281) 530-3735
Mailing address
9009 BOONE RD, HOUSTON, TX 77099-2033
(281) 530-0000
(281) 530-3735
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
00080900
TX
320800000X
Mental Illness Community Based Residential Treatment Facility
00098700
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00080900
PERSONAL CARE HOME
TX
01
—
00098700
PERSONAL CARE HOME
TX
Enumeration date
03/15/2008
Last updated
03/15/2008
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