Provider Demographics
NPI:1407133184
Name:DESIRE TO LIVE
Entity type:Organization
Organization Name:DESIRE TO LIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:832-512-3863
Mailing Address - Street 1:3083 SILVER CEDAR TRL
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-6280
Mailing Address - Country:US
Mailing Address - Phone:832-512-3863
Mailing Address - Fax:281-331-0453
Practice Address - Street 1:2220 COUNTY ROAD 144
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-7847
Practice Address - Country:US
Practice Address - Phone:832-512-3863
Practice Address - Fax:281-331-0453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX132672311500000X, 3104A0625X, 3104A0630X, 310500000X, 311ZA0620X, 315P00000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities