Organization
PREMIEANT INC
Active
Other names
Pendleton
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DENNIS R LATIMER (CEO)
(512) 916-1632
Entity
Organization
Contact information
Practice address
1304 QUAIL PARK, AUSTIN, TX 78753
(512) 916-1632
(512) 916-1639
Mailing address
1110 WEST WILLIAM CANNON, BUILDING 2, AUSTIN, TX 78745
(512) 916-1632
(512) 916-1639
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
3661
TX
Other
Enumeration date
08/31/2006
Last updated
08/22/2020
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