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General NPI Number Information
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NPI Number | 1982889655
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Entity Type | Organization
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Legal Business Name | DEONDRA R HARDEMON
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 08/29/2008
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Provider Practice Location Address
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Address Line | 4006 RIPPLEBROOK DR
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City | HOUSTON
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State | TX
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Zip | 77045-5518
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Country | US
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Telephone | 713-933-9595
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Fax | 866-703-8463
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Provider Business Mailing Address
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Address Line | 4006 RIPPLEBROOK DR
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City | HOUSTON
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State | TX
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Zip | 77045-5518
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Country | US
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Telephone | 713-933-9595
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Fax | 866-703-8463
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Authorized Official
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Title or Position | CEO
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Name | MS. DEONDRA ROCHELLE HARDEMON
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Credential |
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Telephone | 713-933-9595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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