Healthcare Provider Details

I. General information

NPI: 1194222570
Provider Name (Legal Business Name): S-N-S HOUSE OF CARE, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E US HIGHWAY 80
WHITE OAK TX
75693-2103
US

IV. Provider business mailing address

3549 GILMER RD STE I
LONGVIEW TX
75604-1216
US

V. Phone/Fax

Practice location:
  • Phone: 430-625-7183
  • Fax: 430-625-7177
Mailing address:
  • Phone: 903-215-9411
  • Fax: 430-625-7208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: SHELLONDA PRUITT
Title or Position: OWNER/PROGRAM DIRECTOR
Credential:
Phone: 903-215-9411