Provider Demographics
NPI:1508998261
Name:TEXARKANA RESOURCES FOR THE DISABLED, INC.
Entity Type:Organization
Organization Name:TEXARKANA RESOURCES FOR THE DISABLED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-774-9675
Mailing Address - Street 1:PO BOX 19
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75504-0019
Mailing Address - Country:US
Mailing Address - Phone:870-774-9675
Mailing Address - Fax:870-773-0578
Practice Address - Street 1:3015 E 19TH ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-4831
Practice Address - Country:US
Practice Address - Phone:870-774-9675
Practice Address - Fax:870-773-0578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 320900000X
AR251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR132807724Medicaid