Provider Demographics
NPI:1215041132
Name:SPECIAL TEXAS HOMES INC
Entity Type:Organization
Organization Name:SPECIAL TEXAS HOMES INC
Other - Org Name:SAN JACINTO LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JERRINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-445-6470
Mailing Address - Street 1:4115 GALVESTON ROAD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77017-2518
Mailing Address - Country:US
Mailing Address - Phone:713-475-2228
Mailing Address - Fax:713-475-2332
Practice Address - Street 1:2406 SAN JACINTO STREET
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502
Practice Address - Country:US
Practice Address - Phone:713-941-7322
Practice Address - Fax:713-475-2332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
117610315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45G878Medicaid