Provider Demographics
NPI:1982807897
Name:KEITH MARTEL TAYLOR
Entity type:Organization
Organization Name:KEITH MARTEL TAYLOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:PHELPS
Authorized Official - Last Name:HOSEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-847-1883
Mailing Address - Street 1:440 BENMAR DR
Mailing Address - Street 2:#1225
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-3165
Mailing Address - Country:US
Mailing Address - Phone:281-847-1883
Mailing Address - Fax:281-847-1845
Practice Address - Street 1:440 BENMAR DR STE 1225
Practice Address - Street 2:1225
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3165
Practice Address - Country:US
Practice Address - Phone:281-847-1883
Practice Address - Fax:281-847-1845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities