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General NPI Number Information
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NPI Number | 1770358079
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Entity Type | Organization
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Legal Business Name | DIVINE FAVOR TRANSITIONAL LIVING FACILITY
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Dates
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Enumeration Date | 11/17/2023
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Last Update Date | 05/26/2024
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Provider Practice Location Address
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Address Line | 16714 SIDONIE DR
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City | HOUSTON
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State | TX
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Zip | 77053-2562
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Country | US
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Telephone | 832-338-6350
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Fax | 833-241-7558
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Provider Business Mailing Address
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Address Line | 13010 OLEANDER BAY LN
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City | TEXAS CITY
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State | TX
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Zip | 77568-2218
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Country | US
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Telephone | 832-338-6350
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Fax | 833-241-7558
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CRYSTAL ALEXIA JEFFREY
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Credential |
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Telephone | 832-338-6350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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