Provider Demographics
NPI:1497158216
Name:ET TRANSITIONAL LIVING
Entity Type:Organization
Organization Name:ET TRANSITIONAL LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-753-7685
Mailing Address - Street 1:503 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-6604
Mailing Address - Country:US
Mailing Address - Phone:903-753-7685
Mailing Address - Fax:903-753-7686
Practice Address - Street 1:503 N 6TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6604
Practice Address - Country:US
Practice Address - Phone:903-753-7685
Practice Address - Fax:903-753-7686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health