Provider Demographics
NPI:1063624237
Name:S & G COMMUNITY LIVING CENTER, INC.
Entity type:Organization
Organization Name:S & G COMMUNITY LIVING CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MULKEY
Authorized Official - Suffix:
Authorized Official - Credentials:QMRP
Authorized Official - Phone:713-598-1471
Mailing Address - Street 1:P.O. BOX 686
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77574
Mailing Address - Country:US
Mailing Address - Phone:713-598-1471
Mailing Address - Fax:281-334-7850
Practice Address - Street 1:7865 PECAN VILLAS
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77061
Practice Address - Country:US
Practice Address - Phone:713-598-1471
Practice Address - Fax:281-334-7850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320900000X
TX117286315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities