Provider Demographics
NPI:1164174652
Name:THE DETIVEAUX CORPORATION
Entity Type:Organization
Organization Name:THE DETIVEAUX CORPORATION
Other - Org Name:GRISWOLD HOMECARE OF NORTH HOUSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GRISWOLD HOMECARE OF
Authorized Official - Middle Name:NORTH
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-859-1098
Mailing Address - Street 1:431 NURSERY RD STE A400
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1986
Mailing Address - Country:US
Mailing Address - Phone:832-280-6245
Mailing Address - Fax:
Practice Address - Street 1:431 NURSERY RD STE A400
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-1986
Practice Address - Country:US
Practice Address - Phone:832-280-6245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020273OtherTX HEALTH & HUMAN SERVICES - PAS SERVICES