Organization · NPI-2
1house Of Micah
Custodial Care Facility, Adult Care Home · Wylie, TX
NPI number1104219096
StatusActive
Last updated in NPPESMar 17, 2015
Details
- NPI
- 1104219096
- Entity type
- Organization (NPI-2)
- Legal business name
- 1house Of Micah
- Organization subpart
- No
- Enumeration date
- Mar 17, 2015
- Last updated
- Mar 17, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 311ZA0620X | Custodial Care Facility, Adult Care Home | – | – | Yes |
| 104100000X | Social Worker | 56214 | TX | |
| 251C00000X | Day Training, Developmentally Disabled Services | – | – | |
| 311Z00000X | Custodial Care Facility | – | – | |
| 320600000X | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | – | – | |
| 320700000X | Residential Treatment Facility, Physical Disabilities | – | – | |
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | – | – | |
| 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | – | – |
Practice location
600 Woodbridge PkwyUnit 2133
Wylie, TX 75098-7047
Phone 469-478-7106
Mailing address
600 Woodbridge PkwyUnit 2133
Wylie, TX 75098-7047
Phone 469-478-7106
Authorized official
Jamila Gilliam
Owner
4694787106
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