Provider Demographics
NPI:1114797263
Name:DEMETRICIA D. WEATHERSBY FOUNDATION LLC
Entity Type:Organization
Organization Name:DEMETRICIA D. WEATHERSBY FOUNDATION LLC
Other - Org Name:DDW FOUNDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-815-5389
Mailing Address - Street 1:400 N ERVAY ST UNIT 132220
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75313-0219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8455 GRACE ST APT 1009
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4146
Practice Address - Country:US
Practice Address - Phone:214-815-5389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251G00000XAgenciesHospice Care, Community Based
No342000000XTransportation ServicesTransportation Network Company
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No347E00000XTransportation ServicesTransportation Broker