Provider Demographics
NPI:1831405364
Name:THE HOUSE OF DAVID GROUP HOME
Entity type:Organization
Organization Name:THE HOUSE OF DAVID GROUP HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:KIDADA
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-256-8637
Mailing Address - Street 1:6422 HILLMAN GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77086-2834
Mailing Address - Country:US
Mailing Address - Phone:713-256-8637
Mailing Address - Fax:281-448-3632
Practice Address - Street 1:6422 HILLMAN GLEN CIR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77086-2834
Practice Address - Country:US
Practice Address - Phone:713-256-8637
Practice Address - Fax:281-448-3632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-21
Last Update Date:2010-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities