Organization
A WAY OF LIFE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRYMI D MATHIS (CEO)
(469) 735-3395
Entity
Organization
Contact information
Practice address
3455 HIGHLAND RD # 101, DALLAS, TX 75228-7193
(469) 735-5852
(469) 941-4158
Mailing address
8501 BAUMGARTEN DR, DALLAS, TX 75228-5416
(469) 735-5852
(469) 941-4158
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/20/2021
Last updated
08/08/2023
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