Provider Demographics
NPI:1821264490
Name:CORA & OZELE HOME 4 YOUTH
Entity Type:Organization
Organization Name:CORA & OZELE HOME 4 YOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAVETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-563-4970
Mailing Address - Street 1:13611 ORTEGA LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-3435
Mailing Address - Country:US
Mailing Address - Phone:832-563-4970
Mailing Address - Fax:281-933-1842
Practice Address - Street 1:13611 ORTEGA LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-3435
Practice Address - Country:US
Practice Address - Phone:832-563-4970
Practice Address - Fax:281-933-1842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility