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General NPI Number Information
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NPI Number | 1205438116
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Entity Type | Organization
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Legal Business Name | ASTA LIFE HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 11/15/2020
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 29536 FULSHEAR LAKE TRCE
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City | RICHMOND
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State | TX
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Zip | 77406-3312
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Country | US
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Telephone | 832-638-1954
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Fax |
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Provider Business Mailing Address
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Address Line | 27707 ROCKY CREEK CT
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City | FULSHEAR
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State | TX
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Zip | 77441-1113
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Country | US
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Telephone | 832-638-1954
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | ANDRE ABRAHAM
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Credential |
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Telephone | 832-638-1954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 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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