Provider Demographics
NPI:1942571740
Name:VERIZON HEALTH RESOURCES LLC
Entity Type:Organization
Organization Name:VERIZON HEALTH RESOURCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JORFUI
Authorized Official - Middle Name:DOLLY
Authorized Official - Last Name:KANDEH-DABO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-595-1733
Mailing Address - Street 1:5202 EMORY MILL RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-7120
Mailing Address - Country:US
Mailing Address - Phone:832-595-1733
Mailing Address - Fax:832-595-1760
Practice Address - Street 1:5202 EMORY MILL RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-7120
Practice Address - Country:US
Practice Address - Phone:832-595-1733
Practice Address - Fax:832-595-1760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities