Provider Demographics
NPI:1316380223
Name:1ST LIFE PLANNING RESIDENTIAL, LLC
Entity Type:Organization
Organization Name:1ST LIFE PLANNING RESIDENTIAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-618-1722
Mailing Address - Street 1:3939 BELT LINE RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4323
Mailing Address - Country:US
Mailing Address - Phone:972-964-3444
Mailing Address - Fax:
Practice Address - Street 1:3939 BELT LINE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4323
Practice Address - Country:US
Practice Address - Phone:972-964-3444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities