Provider Demographics
NPI:1770017550
Name:HYDE, FELICIA
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:HYDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOR
Other - Middle Name:
Other - Last Name:RELIABLE HEALTHCARE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSCST
Mailing Address - Street 1:135 ANNE'S WAY
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477
Mailing Address - Country:US
Mailing Address - Phone:832-563-6987
Mailing Address - Fax:
Practice Address - Street 1:135 ANNES WAY
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5446
Practice Address - Country:US
Practice Address - Phone:832-563-6987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX065561310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility