Provider Demographics
NPI:1720416852
Name:DISCOVERY COMMUNITY OF HOUSTON
Entity Type:Organization
Organization Name:DISCOVERY COMMUNITY OF HOUSTON
Other - Org Name:HOUSTON DISCOVERY COMMUNITY/HDC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-217-8645
Mailing Address - Street 1:2330 CAMDEN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-1010
Mailing Address - Country:US
Mailing Address - Phone:832-543-3472
Mailing Address - Fax:713-774-0631
Practice Address - Street 1:6714 TAM O SHANTER LN
Practice Address - Street 2:5903 REDDING RD
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4948
Practice Address - Country:US
Practice Address - Phone:832-543-3472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3671-3672324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3471-3472OtherTEXAS DEPT OF STATE HEALTH SERVICES REGULATORY LICENSING UNIT