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General NPI Number Information
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NPI Number | 1568388502
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Entity Type | Organization
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Legal Business Name | COMMUNITY GUIDED LIVING 'CGL'
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Dates
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Enumeration Date | 06/24/2026
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Last Update Date | 06/24/2026
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Provider Practice Location Address
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Address Line | 10779 SORA DR
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City | WILLIS
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State | TX
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Zip | 77378-2258
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Country | US
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Telephone | 951-229-6039
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Fax |
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Provider Business Mailing Address
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Address Line | 10779 SORA DR
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City | WILLIS
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State | TX
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Zip | 77378-2258
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Country | US
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Telephone | 951-229-6039
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SAN JUANITA ROUNTREE
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Credential |
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Telephone | 951-229-6039
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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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Taxonomy #2
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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