Provider Demographics
NPI:1689277303
Name:LITTLE HOMES ON ICE INC
Entity Type:Organization
Organization Name:LITTLE HOMES ON ICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:DALA
Authorized Official - Middle Name:
Authorized Official - Last Name:EWEKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-912-9957
Mailing Address - Street 1:13327 BIRCH GROVE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-6224
Mailing Address - Country:US
Mailing Address - Phone:281-912-9957
Mailing Address - Fax:
Practice Address - Street 1:13327 BIRCH GROVE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-6224
Practice Address - Country:US
Practice Address - Phone:281-912-9957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities