MEDICARE: DEONDRA R HARDEMON

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
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1982889655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEONDRA R HARDEMON

Provider Business Mailing Address
First Line	:	4006 RIPPLEBROOK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-5518
Country	:	US
Telephone Number	:	713-933-9595
Fax Number	:	866-703-8463

Provider Business Practice Location Address
First Line	:	4006 RIPPLEBROOK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-5518
Country	:	US
Telephone Number	:	713-933-9595
Fax Number	:	866-703-8463

Authorized Official
Title or Position	:	CEO
Name	:	MS. DEONDRA ROCHELLE HARDEMON
Credential	:
Telephone Number	:	713-933-9595

Provider Enumeration Date	:	12/31/2007
Last Update Date	:	08/29/2008

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Directions to “DEONDRA R HARDEMON ” Practice Location

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