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General NPI Number Information
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NPI Number | 1679825491
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Entity Type | Organization
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Legal Business Name | AUSTIN CHILDRENS SHELTER
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Dates
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Enumeration Date | 10/03/2012
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Last Update Date | 10/04/2012
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Provider Practice Location Address
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Address Line | 4800 MANOR RD
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City | AUSTIN
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State | TX
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Zip | 78723-5471
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Country | US
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Telephone | 512-927-4717
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Fax |
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Provider Business Mailing Address
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Address Line | 10701 SORGHUM HILL CV
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City | AUSTIN
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State | TX
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Zip | 78754-5411
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF RESIDENTIAL SERVICES
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Name | MS. SHEERIN SARA ABBAS HALL
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Credential | LMSW
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Telephone | 512-927-4717
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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 | 220041135
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License Number State | TX
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