Healthcare Provider Details

I. General information

NPI: 1861708265
Provider Name (Legal Business Name): CARRIE ASSISTANT LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 E RANDOL MILL RD SUITE 160
ARLINGTON TX
76011-5839
US

IV. Provider business mailing address

306 E RANDOL MILL RD SUITE 160
ARLINGTON TX
76011-5839
US

V. Phone/Fax

Practice location:
  • Phone: 817-461-0154
  • Fax:
Mailing address:
  • Phone: 817-461-0154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: BALINDA JEAN ANTOINE
Title or Position: CEO
Credential:
Phone: 817-461-0154