Provider Demographics
NPI:1194197855
Name:A LIFE OF SERVICE INC
Entity Type:Organization
Organization Name:A LIFE OF SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RASHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-628-1926
Mailing Address - Street 1:1536 HAWTHORNE ST
Mailing Address - Street 2:2
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-3660
Mailing Address - Country:US
Mailing Address - Phone:832-628-1926
Mailing Address - Fax:
Practice Address - Street 1:1536 HAWTHORNE ST
Practice Address - Street 2:2
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-3660
Practice Address - Country:US
Practice Address - Phone:832-628-1926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251C00000X, 251S00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care