Provider Demographics
NPI:1417015322
Name:INDEPENDENT LIVING OF TEXARKANA, LLC
Entity Type:Organization
Organization Name:INDEPENDENT LIVING OF TEXARKANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:FAGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-831-3911
Mailing Address - Street 1:3120 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-4083
Mailing Address - Country:US
Mailing Address - Phone:903-831-3911
Mailing Address - Fax:903-831-4195
Practice Address - Street 1:3120 SMITH ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-4083
Practice Address - Country:US
Practice Address - Phone:903-831-3911
Practice Address - Fax:903-831-4195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118529310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility