Organization
GIVING OPTIONS FOR AN INDEPENDENT LIFE WITH SUPPORTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN L VARDELL (PROGRAM MANAGER)
(903) 868-4163
Entity
Organization
Contact information
Practice address
1531 N SHANNON ST, SHERMAN, TX 75092-3743
(903) 868-4163
Mailing address
1531 N SHANNON ST, SHERMAN, TX 75092-3743
(903) 868-4163
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
NONE
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NONE
TX
Enumeration date
07/10/2009
Last updated
07/10/2009
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