Provider Demographics
NPI:1093179145
Name:ABIDING RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:ABIDING RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LA TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-315-8302
Mailing Address - Street 1:411 N FREDONIA ST STE 109
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-6467
Mailing Address - Country:US
Mailing Address - Phone:903-234-8214
Mailing Address - Fax:903-234-8138
Practice Address - Street 1:205 E US HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:TX
Practice Address - Zip Code:75693-2103
Practice Address - Country:US
Practice Address - Phone:903-297-4959
Practice Address - Fax:903-297-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143093310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001020325Medicaid
TX001019579Medicaid
TX001016175Medicaid