Provider Demographics
NPI:1538484118
Name:ADDIE'S COMMUNITY DEVELOPMENT CORP.
Entity Type:Organization
Organization Name:ADDIE'S COMMUNITY DEVELOPMENT CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BRITTIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-513-2476
Mailing Address - Street 1:2610 IVY ST.
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77026
Mailing Address - Country:US
Mailing Address - Phone:281-513-2476
Mailing Address - Fax:
Practice Address - Street 1:2610 IVY ST.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026
Practice Address - Country:US
Practice Address - Phone:281-513-2476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000333332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies