Provider Demographics
NPI:1154527224
Name:LINDA JILL SOWELL
Entity type:Organization
Organization Name:LINDA JILL SOWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:SOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:903-593-2722
Mailing Address - Street 1:7284 HILL N DALE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75709
Mailing Address - Country:US
Mailing Address - Phone:903-593-2722
Mailing Address - Fax:903-593-2722
Practice Address - Street 1:7284 HILL N DALE RD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75709-4102
Practice Address - Country:US
Practice Address - Phone:903-593-2722
Practice Address - Fax:903-593-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities