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General NPI Number Information
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NPI Number | 1710045067
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Entity Type | Organization
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Legal Business Name | ELLIOTT&JOYCE LANGSTON
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10401 LAKE TER
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City | HURST
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State | TX
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Zip | 76053-7836
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Country | US
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Telephone | 817-283-0794
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Fax | 817-590-8305
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Provider Business Mailing Address
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Address Line | 10401 LAKE TER
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City | HURST
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State | TX
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Zip | 76053-7836
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Country | US
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Telephone | 817-283-0794
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Fax | 817-590-8305
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Authorized Official
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Title or Position | CASE MANAGER
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Name | MR. ELLIOTT LANGSTON
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Credential | GENERAL PARTNER
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Telephone | 817-283-0794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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