Organization
PREMIER COMMUNITY LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TARA LYNN JACKSON (MEMBERMANAGER)
(817) 987-2649
Entity
Organization
Contact information
Practice address
1013 MARIANA DR, WAKE VILLAGE, TX 75501-6212
(903) 832-2975
Mailing address
1013 MARIANA DR, WAKE VILLAGE, TX 75501-6212
(903) 832-2975
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/10/2007
Last updated
08/22/2020
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