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General NPI Number Information
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NPI Number | 1821126707
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Entity Type | Organization
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Legal Business Name | STATE OF TEXAS, DEPT. OF AGING & DISABILITY, HCSSA
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10205 N LAMAR FIRST FLOOR
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City | AUSTIN
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State | TX
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Zip | 78753
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Country | US
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Telephone | 512-908-3204
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Fax | 512-908-3212
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Provider Business Mailing Address
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Address Line | 2900 W ANDERSON LN C200-126
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City | AUSTIN
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State | TX
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Zip | 78757-1102
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Country | US
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Telephone | 512-484-4907
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Fax | 512-908-3212
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Authorized Official
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Title or Position | MANAGER
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Name | MR. BILL JACKSON
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Credential | MSW
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Telephone | 512-908-3203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 236258
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License Number State | TX
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