Provider Demographics
NPI:1780340778
Name:DIMALISE LLC
Entity type:Organization
Organization Name:DIMALISE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-483-7689
Mailing Address - Street 1:606 COLDSTONE CT
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4989
Mailing Address - Country:US
Mailing Address - Phone:832-483-7689
Mailing Address - Fax:
Practice Address - Street 1:606 COLDSTONE CT
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-4989
Practice Address - Country:US
Practice Address - Phone:832-483-7689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-13
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based