Provider Demographics
NPI:1821126707
Name:STATE OF TEXAS, DEPT. OF AGING & DISABILITY, HCSSA
Entity Type:Organization
Organization Name:STATE OF TEXAS, DEPT. OF AGING & DISABILITY, HCSSA
Other - Org Name:HOME & COMMUNITY SUPPORT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:512-908-3203
Mailing Address - Street 1:2900 W ANDERSON LN
Mailing Address - Street 2:C200-126
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1102
Mailing Address - Country:US
Mailing Address - Phone:512-484-4907
Mailing Address - Fax:512-908-3212
Practice Address - Street 1:10205 N LAMAR
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753
Practice Address - Country:US
Practice Address - Phone:512-908-3204
Practice Address - Fax:512-908-3212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX236258251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care