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SHACKLEFREE MINISTRIES NPI 1356695480


NPI Information

NPI: 1356695480
Provider Name: SHACKLEFREE MINISTRIES
Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
409 N FREDONIA ST
SUITE 116
LONGVIEW, TX
ZIP 75601
Phone: (903) 917-6632
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SHACKLEFREE MINISTRIES is a community based residential treatment facility, intellectual and/or developmental disabilities in Longview, TX. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. SHACKLEFREE MINISTRIES NPI is 1356695480. The provider is registered as an organization entity type.

The provider's business location address is:

409 N FREDONIA ST
SUITE 116
LONGVIEW, TX
ZIP 75601-466
Phone: (903) 917-6632

The provider's authorized official is Virginia Lea Taylor .
The authorized official title is Christian Counselor and has the following contact phone number (903) 917-6632.

The enumeration date for this NPI number is 10/26/2012 and was last updated on 10/26/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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