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NPI Code Detail

MEDICARE: DEOLYVER AGING AND DISABILITY SUPPORT SERVICES, LLC

MEDICARE: DEOLYVER AGING AND DISABILITY SUPPORT SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251J00000XNursing Care Agency
2343900000XNon-emergency Medical Transport (VAN)
3251B00000XCase Management Agency
4310400000XAssisted Living Facility

General Provider Information

NPI Number : 1649615618
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEOLYVER AGING AND DISABILITY SUPPORT SERVICES, LLC
Provider Business Mailing Address
First Line : 8313 SOUTHWEST FWY
Second Line : 112
City : HOUSTON
State : TX
Zip : 77074-1611
Country : US
Telephone Number : 713-365-0101
Fax Number : 832-365-7986
Provider Business Practice Location Address
First Line : 1423 LAZY SPRING DR
Second Line :
City : MISSOURI CITY
State : TX
Zip : 77489-5213
Country : US
Telephone Number : 832-230-0343
Fax Number : 832-365-7986
Authorized Official
Title or Position : PRESIDENT
Name : MS. DEMETRIA L HALLEY
Credential : MBA
Telephone Number : 713-365-0101
Provider Enumeration Date : 05/05/2013
Last Update Date : 01/09/2014

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Directions to “DEOLYVER AGING AND DISABILITY SUPPORT SERVICES, LLC ” Practice Location

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