Provider Demographics
NPI:1992055024
Name:ABILITY-RESIDENTIAL LIVING ASSISTANCE
Entity type:Organization
Organization Name:ABILITY-RESIDENTIAL LIVING ASSISTANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:N
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-237-9988
Mailing Address - Street 1:PO BOX 7905
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75607-7905
Mailing Address - Country:US
Mailing Address - Phone:903-237-9988
Mailing Address - Fax:903-291-0123
Practice Address - Street 1:1112 ACAPULCO LN
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:TX
Practice Address - Zip Code:75693-3046
Practice Address - Country:US
Practice Address - Phone:903-237-9988
Practice Address - Fax:903-291-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCDSAMedicaid
TXHCSSAMedicaid