Provider Demographics
NPI:1740879782
Name:SHEAD, GREGORY D
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
Last Name:SHEAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14511 JESSICA FALLS CIR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-4969
Mailing Address - Country:US
Mailing Address - Phone:281-900-4147
Mailing Address - Fax:
Practice Address - Street 1:14511 JESSICA FALLS CIR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-4969
Practice Address - Country:US
Practice Address - Phone:281-900-4147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child