Provider Demographics
NPI:1649615618
Name:DEOLYVER AGING AND DISABILITY SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:DEOLYVER AGING AND DISABILITY SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEMETRIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:713-365-0101
Mailing Address - Street 1:8313 SOUTHWEST FWY
Mailing Address - Street 2:112
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1611
Mailing Address - Country:US
Mailing Address - Phone:713-365-0101
Mailing Address - Fax:832-365-7986
Practice Address - Street 1:1423 LAZY SPRING DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-5213
Practice Address - Country:US
Practice Address - Phone:832-230-0343
Practice Address - Fax:832-365-7986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-05
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251J00000XAgenciesNursing Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251B00000XAgenciesCase Management