=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598071458
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DELL HOUSE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2010
-----------------------------------------------------
Last Update Date | 08/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4309 FERNWOOD DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77021-1640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-701-1097
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4309 FERNWOOD DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77021-1640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-701-1097
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE ADMINISTRATOR/OWNER
-----------------------------------------------------
Name | GLORIA J LITTLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-701-1097
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------