Provider Demographics
NPI:1184619553
Name:DIVERSITY GROUP, LC
Entity type:Organization
Organization Name:DIVERSITY GROUP, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WEATHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-365-0429
Mailing Address - Street 1:2317 BINGLE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-1106
Mailing Address - Country:US
Mailing Address - Phone:713-365-0429
Mailing Address - Fax:713-365-6581
Practice Address - Street 1:2317 BINGLE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-1106
Practice Address - Country:US
Practice Address - Phone:713-365-0429
Practice Address - Fax:713-365-9581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113536315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities