Provider Demographics
NPI:1174012900
Name:BRENDA DICKENS HOUSE OF PEACE
Entity Type:Organization
Organization Name:BRENDA DICKENS HOUSE OF PEACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-438-8166
Mailing Address - Street 1:6619 INDIAN FALLS DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-2633
Mailing Address - Country:US
Mailing Address - Phone:281-438-8166
Mailing Address - Fax:346-888-5285
Practice Address - Street 1:6619 INDIAN FALLS DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-2633
Practice Address - Country:US
Practice Address - Phone:281-438-8166
Practice Address - Fax:346-888-5285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child