Provider Demographics
NPI:1720132814
Name:BJ LIVING CENTER, INC
Entity Type:Organization
Organization Name:BJ LIVING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:OMO
Authorized Official - Last Name:ELABOR
Authorized Official - Suffix:
Authorized Official - Credentials:PROVIDER
Authorized Official - Phone:713-784-1787
Mailing Address - Street 1:3945 BRAXTON DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-6303
Mailing Address - Country:US
Mailing Address - Phone:713-784-1787
Mailing Address - Fax:713-784-4701
Practice Address - Street 1:3945 BRAXTON DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-6303
Practice Address - Country:US
Practice Address - Phone:713-784-1787
Practice Address - Fax:713-784-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YM0800X
251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty