Individual
MS. DEMETRIA RENEE FAIRLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8310 ROSE PETALS LN, ROSHARON, TX 77583-1907
(346) 305-1688
Mailing address
8310 ROSE PETALS LN, ROSHARON, TX 77583-1907
(346) 305-1688
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
04/04/2014
Last updated
03/15/2021
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