Provider Demographics
NPI:1831491489
Name:CRADLE LIVING
Entity Type:Organization
Organization Name:CRADLE LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHILIPPA
Authorized Official - Middle Name:IFEOMA
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN,
Authorized Official - Phone:214-675-4732
Mailing Address - Street 1:18 KESTREL CT
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-2043
Mailing Address - Country:US
Mailing Address - Phone:214-675-4732
Mailing Address - Fax:
Practice Address - Street 1:18 KESTREL CT
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-2043
Practice Address - Country:US
Practice Address - Phone:214-675-4732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX758931320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities