Provider Demographics
NPI:1841558582
Name:ST. NICHOLAS OPERATIONS LLC
Entity Type:Organization
Organization Name:ST. NICHOLAS OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:PEAKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-271-7777
Mailing Address - Street 1:11727 S SAM HOUSTON PKWY W
Mailing Address - Street 2:SUITE D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77031-2342
Mailing Address - Country:US
Mailing Address - Phone:713-271-7777
Mailing Address - Fax:713-271-8585
Practice Address - Street 1:4612 HEATHERBROOK DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-7634
Practice Address - Country:US
Practice Address - Phone:713-271-7777
Practice Address - Fax:713-271-8585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities