Provider Demographics
NPI:1154176378
Name:IDA CARE HOMES
Entity type:Organization
Organization Name:IDA CARE HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAWANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-730-6030
Mailing Address - Street 1:2000 E LAMAR BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-7361
Mailing Address - Country:US
Mailing Address - Phone:903-480-0160
Mailing Address - Fax:
Practice Address - Street 1:2000 E LAMAR BLVD STE 600
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-7361
Practice Address - Country:US
Practice Address - Phone:903-480-0160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities