Provider Demographics
NPI:1962866178
Name:COLOSSIANS 3 12 LLC
Entity Type:Organization
Organization Name:COLOSSIANS 3 12 LLC
Other - Org Name:CARING SENIOR SERVICE OF CENTRAL TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:GLYNN
Authorized Official - Last Name:RECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-415-6183
Mailing Address - Street 1:PO BOX 1643
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-1643
Mailing Address - Country:US
Mailing Address - Phone:512-415-6183
Mailing Address - Fax:
Practice Address - Street 1:5555 N LAMAR BLVD
Practice Address - Street 2:SUITE K-100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-1073
Practice Address - Country:US
Practice Address - Phone:512-310-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care