Provider Demographics
NPI:1861708265
Name:CARRIE ASSISTANT LIVING
Entity type:Organization
Organization Name:CARRIE ASSISTANT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BALINDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ANTOINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-461-0154
Mailing Address - Street 1:306 E RANDOL MILL RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-5839
Mailing Address - Country:US
Mailing Address - Phone:817-461-0154
Mailing Address - Fax:
Practice Address - Street 1:306 E RANDOL MILL RD
Practice Address - Street 2:SUITE 160
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5839
Practice Address - Country:US
Practice Address - Phone:817-461-0154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities