Provider Demographics
NPI:1982889655
Name:DEONDRA R HARDEMON
Entity type:Organization
Organization Name:DEONDRA R HARDEMON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEONDRA
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:HARDEMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-933-9595
Mailing Address - Street 1:4006 RIPPLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-5518
Mailing Address - Country:US
Mailing Address - Phone:713-933-9595
Mailing Address - Fax:866-703-8463
Practice Address - Street 1:4006 RIPPLEBROOK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-5518
Practice Address - Country:US
Practice Address - Phone:713-933-9595
Practice Address - Fax:866-703-8463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities