Provider Demographics
NPI:1700099314
Name:PUEBLO RESIDENTIAL SERVICES LTD
Entity Type:Organization
Organization Name:PUEBLO RESIDENTIAL SERVICES LTD
Other - Org Name:LAWYER'S PLACE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-345-8273
Mailing Address - Street 1:1317 LAWYERS LN
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-1912
Mailing Address - Country:US
Mailing Address - Phone:325-673-2559
Mailing Address - Fax:325-673-2559
Practice Address - Street 1:1317 LAWYERS LN
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-1912
Practice Address - Country:US
Practice Address - Phone:325-673-2559
Practice Address - Fax:325-673-2559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115628315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities