Provider Demographics
NPI:1992170161
Name:DIABETES AMERICA, LLC
Entity type:Organization
Organization Name:DIABETES AMERICA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:NAKEVA
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-840-5153
Mailing Address - Street 1:4011 AVENUE S 1/2
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-8637
Mailing Address - Country:US
Mailing Address - Phone:409-795-1344
Mailing Address - Fax:
Practice Address - Street 1:13100 NORTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-6310
Practice Address - Country:US
Practice Address - Phone:832-237-3500
Practice Address - Fax:281-897-9906
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DCOA-PA, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80784133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT80784OtherLD