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NPI Code Detail

MEDICARE: DIVINE FAVOR TRANSITIONAL LIVING FACILITY

MEDICARE: DIVINE FAVOR TRANSITIONAL LIVING FACILITY
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
1251S00000XCommunity/Behavioral Health Agency
2101YA0400XAddiction (Substance Use Disorder) Counselor
3251B00000XCase Management Agency
4261QR0800XRecovery Care Clinic/Center
5310400000XAssisted Living Facility
6332U00000XHome Delivered Meals
7261QM0850XAdult Mental Health Clinic/Center

General Provider Information

NPI Number : 1770358079
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIVINE FAVOR TRANSITIONAL LIVING FACILITY
Provider Business Mailing Address
First Line : 13010 OLEANDER BAY LN
Second Line :
City : TEXAS CITY
State : TX
Zip : 77568-2218
Country : US
Telephone Number : 832-338-6350
Fax Number : 833-241-7558
Provider Business Practice Location Address
First Line : 16714 SIDONIE DR
Second Line :
City : HOUSTON
State : TX
Zip : 77053-2562
Country : US
Telephone Number : 832-338-6350
Fax Number : 833-241-7558
Authorized Official
Title or Position : OWNER
Name : MRS. CRYSTAL ALEXIA JEFFREY
Credential :
Telephone Number : 832-338-6350
Provider Enumeration Date : 11/17/2023
Last Update Date : 05/26/2024

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Directions to “DIVINE FAVOR TRANSITIONAL LIVING FACILITY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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