Provider Demographics
NPI:1588997712
Name:LIFESPAN RESOURCES OF TEXAS, INC.
Entity type:Organization
Organization Name:LIFESPAN RESOURCES OF TEXAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:TIEZO
Authorized Official - Middle Name:DEVOTNAE
Authorized Official - Last Name:ADKISON
Authorized Official - Suffix:
Authorized Official - Credentials:LVN, RAC-CT, CNAC
Authorized Official - Phone:682-433-9750
Mailing Address - Street 1:3918 S DENLEY DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-5617
Mailing Address - Country:US
Mailing Address - Phone:682-433-9750
Mailing Address - Fax:
Practice Address - Street 1:3918 S DENLEY DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-5617
Practice Address - Country:US
Practice Address - Phone:682-433-9750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities