Provider Demographics
NPI:1447481221
Name:HEALTON RESIDENTIAL LIVING
Entity type:Organization
Organization Name:HEALTON RESIDENTIAL LIVING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSHLYN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-577-8504
Mailing Address - Street 1:1900 WALNUT ST
Mailing Address - Street 2:402
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-3544
Mailing Address - Country:US
Mailing Address - Phone:512-507-7687
Mailing Address - Fax:
Practice Address - Street 1:1900 WALNUT ST
Practice Address - Street 2:402
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3544
Practice Address - Country:US
Practice Address - Phone:512-507-7687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTON RESIDENTIAL LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities