Healthcare Provider Details

I. General information

NPI: 1982889655
Provider Name (Legal Business Name): DEONDRA R HARDEMON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4006 RIPPLEBROOK DR
HOUSTON TX
77045-5518
US

IV. Provider business mailing address

4006 RIPPLEBROOK DR
HOUSTON TX
77045-5518
US

V. Phone/Fax

Practice location:
  • Phone: 713-933-9595
  • Fax: 866-703-8463
Mailing address:
  • Phone: 713-933-9595
  • Fax: 866-703-8463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. DEONDRA ROCHELLE HARDEMON
Title or Position: CEO
Credential:
Phone: 713-933-9595