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General NPI Number Information
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NPI Number | 1023770906
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Entity Type | Organization
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Legal Business Name | LASAFE HOME LLC
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Dates
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Enumeration Date | 10/08/2021
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Last Update Date | 10/08/2021
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Provider Practice Location Address
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Address Line | 3306 W WALNUT ST STE 403
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City | GARLAND
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State | TX
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Zip | 75042-7115
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Country | US
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Telephone | 469-900-9766
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Fax | 469-519-0207
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Provider Business Mailing Address
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Address Line | 3306 W WALNUT ST STE 403
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City | GARLAND
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State | TX
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Zip | 75042-7115
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Country | US
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Telephone | 469-900-9766
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Fax | 469-519-0207
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. LUCY ACHAN
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Credential |
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Telephone | 469-900-9766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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