Provider Demographics
NPI:1770358079
Name:DIVINE FAVOR TRANSITIONAL LIVING FACILITY
Entity type:Organization
Organization Name:DIVINE FAVOR TRANSITIONAL LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:ALEXIA
Authorized Official - Last Name:JEFFREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-338-6350
Mailing Address - Street 1:13010 OLEANDER BAY LN
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77568-2218
Mailing Address - Country:US
Mailing Address - Phone:832-338-6350
Mailing Address - Fax:833-241-7558
Practice Address - Street 1:16714 SIDONIE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77053-2562
Practice Address - Country:US
Practice Address - Phone:832-338-6350
Practice Address - Fax:833-241-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2024-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase Management
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No332U00000XSuppliersHome Delivered Meals
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No342000000XTransportation ServicesTransportation Network Company