Healthcare Provider Details

I. General information

NPI: 1093179145
Provider Name (Legal Business Name): ABIDING RESIDENTIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 04/05/2016
Certification Date:
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

411 N FREDONIA ST STE 109
LONGVIEW TX
75601-6467
US

V. Phone/Fax

Practice location:
  • Phone: 903-297-4959
  • Fax: 903-297-4999
Mailing address:
  • Phone: 903-234-8214
  • Fax: 903-234-8138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number143093
License Number StateTX

VIII. Authorized Official

Name: MRS. LA TONYA POLK
Title or Position: OWNER
Credential:
Phone: 903-315-8302