That 1 Home

NPI #1114769130 in Katy, Texas

Provider Information

NPI Number: 1114769130
Entity Type: Organization
Organization Name: That 1 Home
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Jun 10, 2024
Last Updated: Jun 19, 2024

Practice Location

Address: 19126 MOSSY HEDGE LN
City: Katy
State: Texas
ZIP Code: 77449-4133
Phone: (832) 785-4089

Authorized Official

Name: MRS. DEANDRA JOHNSON-EGESI, RN
Title: PROGRAM MANAGER
Phone: (832) 785-4089

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Registered Nurse - Administrator — Administrator	163WA2000X
Case Manager/Care Coordinator	171M00000X
Clinical Nurse Specialist - Long-Term Care — Long-Term Care	364SL0600X
Registered Nurse	163W00000X
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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