Provider Demographics
NPI:1497030035
Name:JOUSHUAS COVENANTS RESIDENTIAL CARE L.L.C.
Entity Type:Organization
Organization Name:JOUSHUAS COVENANTS RESIDENTIAL CARE L.L.C.
Other - Org Name:JOUSHUAS COVENANTS RESIDENTIAL CARE L.L.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-917-3191
Mailing Address - Street 1:8 BROWNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75602-1902
Mailing Address - Country:US
Mailing Address - Phone:903-917-3191
Mailing Address - Fax:
Practice Address - Street 1:8 BROWNWOOD DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75602-1902
Practice Address - Country:US
Practice Address - Phone:903-917-3191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health