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General NPI Number Information
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NPI Number | 1750491791
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Entity Type | Organization
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Legal Business Name | SHEILA ISAAC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/21/2007
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Provider Practice Location Address
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Address Line | 409 S MAIN ST SUITE A
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City | LONGVIEW
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State | TX
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Zip | 75601-7432
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Country | US
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Telephone | 903-758-9886
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Fax |
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Provider Business Mailing Address
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Address Line | 409 S MAIN ST SUITE A
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City | LONGVIEW
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State | TX
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Zip | 75601-7432
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Country | US
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Telephone | 903-758-9886
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Fax | 903-234-0068
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISS SHEILA F ISAAC
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Credential |
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Telephone | 903-758-9886
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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 | 87Y/0000HO87Y
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License Number State | TX
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