Organization
ASTA LIFE HEALTHCARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRE ABRAHAM (PROGRAM MANAGER)
(832) 638-1954
Entity
Organization
Contact information
Practice address
29536 FULSHEAR LAKE TRCE, RICHMOND, TX 77406-3312
(832) 638-1954
Mailing address
27707 ROCKY CREEK CT, FULSHEAR, TX 77441-1113
(832) 638-1954
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
U6752006601
CIGNA
TX
Enumeration date
11/15/2020
Last updated
03/26/2025
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