PREMIER COMMUNITY LIVING NPI 1699824318

NPI Information

NPI: 1699824318
Provider Name: PREMIER COMMUNITY LIVING
Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
1013 MARIANA DR
WAKE VILLAGE, TX
ZIP 75501
Phone: (903) 832-2975
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PREMIER COMMUNITY LIVING is a community based residential treatment facility, intellectual and/or developmental disabilities in Wake Village, TX. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. PREMIER COMMUNITY LIVING NPI is 1699824318. The provider is registered as an organization entity type.

The provider's business location address is:

1013 MARIANA DR
WAKE VILLAGE, TX
ZIP 75501-212
Phone: (903) 832-2975

The provider's authorized official is Tara Lynn Jackson .
The authorized official title is Membermanager and has the following contact phone number (817) 987-2649.

The enumeration date for this NPI number is 1/10/2007 and was last updated on 8/22/2020.

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
1	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities				Yes

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: 5/5/2024

NPI Synchronization or Removal

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