Provider Demographics
NPI:1518229384
Name:CLAUDY'S HOUSE FOR DEVELOPMENTALLY CHALLENGED ADULTS
Entity Type:Organization
Organization Name:CLAUDY'S HOUSE FOR DEVELOPMENTALLY CHALLENGED ADULTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:WILKINSON
Authorized Official - Last Name:BRODEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:214-392-5776
Mailing Address - Street 1:1321 ROWAN AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75223-3033
Mailing Address - Country:US
Mailing Address - Phone:214-826-0018
Mailing Address - Fax:
Practice Address - Street 1:1321 ROWAN AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75223-3033
Practice Address - Country:US
Practice Address - Phone:214-826-0018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities