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General NPI Number Information
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NPI Number | 1184619553
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Entity Type | Organization
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Legal Business Name | DIVERSITY GROUP, LC
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2317 BINGLE RD
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City | HOUSTON
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State | TX
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Zip | 77055-1106
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Country | US
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Telephone | 713-365-0429
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Fax | 713-365-9581
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Provider Business Mailing Address
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Address Line | 2317 BINGLE RD
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City | HOUSTON
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State | TX
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Zip | 77055-1106
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Country | US
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Telephone | 713-365-0429
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Fax | 713-365-6581
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. WANDA K. WEATHERS
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Credential |
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Telephone | 713-365-0429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 113536
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License Number State | TX
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