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General NPI Number Information
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NPI Number | 1104193044
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Entity Type | Organization
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Legal Business Name | HEALING HANDS ASSISTED LIVING LLC
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Dates
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Enumeration Date | 11/21/2011
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 4706 BUESCHER CT
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City | PEARLAND
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State | TX
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Zip | 77584-1284
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Country | US
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Telephone | 404-493-0867
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Fax | 478-741-0449
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Provider Business Mailing Address
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Address Line | 2667 C ST
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City | MACON
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State | GA
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Zip | 31206-8307
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Country | US
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Telephone | 404-493-0867
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Fax | 478-741-0449
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Authorized Official
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Title or Position | OWNER
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Name | TIMISHEA TILLMAN
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Credential |
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Telephone | 404-493-0867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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