Provider Demographics
NPI:1609285238
Name:AHIDI RESIDENCE
Entity Type:Organization
Organization Name:AHIDI RESIDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIOLET
Authorized Official - Middle Name:
Authorized Official - Last Name:ISUFI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-380-7600
Mailing Address - Street 1:10851 W MONFAIR BLVD
Mailing Address - Street 2:APT 5318
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382
Mailing Address - Country:US
Mailing Address - Phone:713-380-7600
Mailing Address - Fax:
Practice Address - Street 1:10851 W MONTFAIR BLVD
Practice Address - Street 2:5318
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2925
Practice Address - Country:US
Practice Address - Phone:713-380-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX479275428320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities