TANITA SHANTA SULLIVAN NPI 1659671147

NPI Information

  • NPI: 1659671147
  • Provider Name: TANITA SHANTA SULLIVAN
  • Classification: Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320600000X
  • Entity Type: Individual
  • Address: 13985 BROKEN ARROW DR
    WILLIS, TX
    ZIP 77378
  • Phone: (936) 856-6136

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NPI Details

Tanita Shanta Sullivan is a residential treatment facility, intellectual and/or developmental disabilities in Willis, TX. The provider is a residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently. Tanita Shanta Sullivan NPI is 1659671147. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

13985 BROKEN ARROW DR
WILLIS, TX
ZIP 77378-323
Phone: (936) 856-6136
Fax: (936) 856-7549

The enumeration date for this NPI number is 10/29/2010 and was last updated on 10/29/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1320700000XResidential Treatment Facility, Physical DisabilitiesNo
2320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesNo
3324500000XSubstance Abuse Rehabilitation FacilityNo
4320600000XResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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