Organization
EMMANUEL RESIDENTIAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LA TONYA S POLK (PROGRAM MANAGER)
(903) 315-8302
Entity
Organization
Contact information
Practice address
1328 HERITAGE BLVD STE 5, LONGVIEW, TX 75605-1472
(903) 260-0412
Mailing address
1328 HERITAGE BLVD STE 5, LONGVIEW, TX 75605-1472
(903) 260-0412
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
310400000X
Assisted Living Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245509504
—
TX
Enumeration date
12/15/2011
Last updated
04/15/2026
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