Provider Demographics
NPI:1346566783
Name:DAVENPORT, NATASHA MONEQUE
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:MONEQUE
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 ATKINS ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-8120
Mailing Address - Country:US
Mailing Address - Phone:214-207-0444
Mailing Address - Fax:469-453-3306
Practice Address - Street 1:2220 SWANSEE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-1422
Practice Address - Country:US
Practice Address - Phone:214-207-0444
Practice Address - Fax:469-453-3306
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251G00000XAgenciesHospice Care, Community Based
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities