Provider Demographics
NPI:1386855625
Name:MAINSTREAM LIVING CENTER LLC
Entity Type:Organization
Organization Name:MAINSTREAM LIVING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:H
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-865-2003
Mailing Address - Street 1:13940 BAMMEL N. HOUSTON
Mailing Address - Street 2:SUITE 304
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066
Mailing Address - Country:US
Mailing Address - Phone:281-440-5103
Mailing Address - Fax:281-440-5105
Practice Address - Street 1:11811 NORTH FWY STE 615
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3239
Practice Address - Country:US
Practice Address - Phone:281-999-5112
Practice Address - Fax:281-999-5113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001008149320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities