Provider Demographics
NPI:1063815983
Name:HISMERCY INCORPORATED, LLC
Entity Type:Organization
Organization Name:HISMERCY INCORPORATED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OLANIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-439-7585
Mailing Address - Street 1:1558 CROWN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5519
Mailing Address - Country:US
Mailing Address - Phone:972-439-7585
Mailing Address - Fax:
Practice Address - Street 1:1558 CROWN VIEW DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5519
Practice Address - Country:US
Practice Address - Phone:972-439-7585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities