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General NPI Number Information
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NPI Number | 1225603871
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Entity Type | Organization
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Legal Business Name | DIVERSE ACHIEVERS LLC
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 29218 FOX FOUNTAIN LN
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City | SPRING
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State | TX
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Zip | 77386-3096
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Country | US
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Telephone | 281-771-4910
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Fax |
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Provider Business Mailing Address
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Address Line | 20330 WHITEWOOD DR APT 5208
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City | SPRING
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State | TX
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Zip | 77373-5562
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD
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Name | MR. CHIBUZO POLYCARP IWEAJUNWA I
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Credential |
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Telephone | 832-296-3123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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