Provider Demographics
NPI:1447797246
Name:CLARA RESIDENTIAL HOME, LLC
Entity Type:Organization
Organization Name:CLARA RESIDENTIAL HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHESIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-212-7002
Mailing Address - Street 1:1302 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-6475
Mailing Address - Country:US
Mailing Address - Phone:214-212-7002
Mailing Address - Fax:
Practice Address - Street 1:1302 BUCKINGHAM DR
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-6475
Practice Address - Country:US
Practice Address - Phone:214-212-7002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities