Provider Demographics
NPI:1437488087
Name:DANAEDES GROUP LLC
Entity Type:Organization
Organization Name:DANAEDES GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANELL
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:JOHNSON-ARZU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-492-2250
Mailing Address - Street 1:2450 LOUISIANA ST
Mailing Address - Street 2:SUITE 400-716
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-2380
Mailing Address - Country:US
Mailing Address - Phone:713-492-2250
Mailing Address - Fax:713-492-2255
Practice Address - Street 1:2450 LOUISIANA ST
Practice Address - Street 2:SUITE 400-716
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-2380
Practice Address - Country:US
Practice Address - Phone:713-492-2250
Practice Address - Fax:713-492-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A6196Medicare UPIN