Organization
QUEEN OF SAFETY SUPPLY CO., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RACHAEL SHANNEL COSTLY (CEO)
(225) 788-7048
Entity
Organization
Contact information
Practice address
9500 COUNTY ROAD 190, MANVEL, TX 77578-5078
(225) 788-7048
Mailing address
PO BOX 720034, HOUSTON, TX 77272-0034
(225) 788-7048
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
04/15/2020
Last updated
04/15/2020
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