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General NPI Number Information
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NPI Number | 1386897452
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Entity Type | Organization
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Legal Business Name | EVERYDAY LIFE INC
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Dates
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Enumeration Date | 11/03/2008
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Last Update Date | 11/03/2008
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Provider Practice Location Address
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Address Line | 6955 BROACH RD
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City | BRYAN
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State | TX
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Zip | 77808-8897
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Country | US
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Telephone | 979-589-1885
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Fax | 979-589-1665
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Provider Business Mailing Address
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Address Line | 6955 BROACH RD
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City | BRYAN
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State | TX
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Zip | 77808-8897
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Country | US
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Telephone | 979-589-1885
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Fax | 979-589-1665
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Authorized Official
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Title or Position | DIRECTOR OF ADMINISTRATION
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Name | MR. CEDRIC LASHUNN PAYTON
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Credential | LCCA,CART,CYC-P
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Telephone | 979-589-1885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 812341
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License Number State | TX
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