1house of Micah

NPI #1104219096 in Wylie, Texas

Provider Information

NPI Number: 1104219096
Entity Type: Organization
Organization Name: 1house of Micah
Primary Specialty: Custodial Care Facility - Adult Care Home
Enumeration Date: Mar 17, 2015
Last Updated: Mar 17, 2015

Practice Location

Address: 600 WOODBRIDGE PKWY
Address 2: UNIT 2133
City: Wylie
State: Texas
ZIP Code: 75098-7047
Phone: (469) 478-7106

Authorized Official

Name: JAMILA GILLIAM, LBSW
Title: OWNER
Phone: (469) 478-7106

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker	104100000X
Day Training, Developmentally Disabled Services	251C00000X
Custodial Care Facility	311Z00000X
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X
Residential Treatment Facility, Physical Disabilities	320700000X
Community Based Residential Treatment Facility, Mental Illness	320800000X
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X
Custodial Care Facility - Adult Care Home — Adult Care Home	311ZA0620X	Primary

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