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General NPI Number Information
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NPI Number | 1972332617
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Entity Type | Organization
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Legal Business Name | DQ REVITALIZATION LLC
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Dates
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Enumeration Date | 07/31/2024
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 15255 FM 529 RD APT 6201
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City | HOUSTON
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State | TX
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Zip | 77095-5645
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Country | US
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Telephone | 504-270-8024
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Fax |
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Provider Business Mailing Address
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Address Line | 15255 FM 529 RD APT 6201
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City | HOUSTON
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State | TX
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Zip | 77095-5645
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Country | US
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Telephone | 504-270-8024
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LATANYA MARIE FOUNTAIN
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Credential | LPN
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Telephone | 504-270-8024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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