St. Nicholas Operations LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

ST. NICHOLAS OPERATIONS LLC

Practice address

4612 Heatherbrook Dr
Dallas, TX 75244-7634

Phone

(713) 271-7777

Fax

(713) 271-8585

NPI assigned

May 1, 2012

Last updated

May 1, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Benjamin Peakes

Title

Manager

Phone

(713) 271-7777

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841558582. Details of each certification follow.

• CCN 45H324 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 45H324

Legal name

ST. NICHOLAS OPERATIONS LLC

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Feb 22, 2012

Last certification

Feb 25, 2026

Beds

6

Ownership / control type

Private (proprietary)

Facility address

4612 Heatherbrook Dr
Dallas, TX 75244

Tax ID family

St Nicholas Operations LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• St. Nicholas Operations LLC

  • Intellectual Disabilities Intermediate Care Facility
  • Houston, TX
  • NPI 1639474869
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335830400000",
    "number": "1841558582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11727 S SAM HOUSTON PKWY W",
            "address_2": "SUITE D",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770312342",
            "telephone_number": "713-271-7777",
            "fax_number": "713-271-8585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4612 HEATHERBROOK DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752447634",
            "telephone_number": "713-271-7777",
            "fax_number": "713-271-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. NICHOLAS OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-01",
        "last_updated": "2012-05-01",
        "status": "A",
        "authorized_official_last_name": "PEAKES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "BENJAMIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "713-271-7777"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lauren St. Tours
• Olivia Hayes Staas

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Dallas, TX
• Providers in Dallas, TX by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.