Healthcare Provider Details

I. General information

NPI: 1669633095
Provider Name (Legal Business Name): ND COMMUNITY SUPPORTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9026 WELLESLEY DR
AUSTIN TX
78754-5016
US

IV. Provider business mailing address

9026 WELLESLEY DR
AUSTIN TX
78754-5016
US

V. Phone/Fax

Practice location:
  • Phone: 512-743-9730
  • Fax:
Mailing address:
  • Phone: 512-743-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. LATONIA TAMARA DAVIDSON
Title or Position: RN-CEO
Credential:
Phone: 512-743-9730