Provider Demographics
NPI:1871879775
Name:AMAZING LIVING HCS, LLC
Entity type:Organization
Organization Name:AMAZING LIVING HCS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRISTAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-917-1115
Mailing Address - Street 1:2206 JAHAN TRL
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2521
Mailing Address - Country:US
Mailing Address - Phone:903-917-1115
Mailing Address - Fax:888-474-6401
Practice Address - Street 1:2206 JAHAN TRL
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2521
Practice Address - Country:US
Practice Address - Phone:903-917-1115
Practice Address - Fax:888-474-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities