Organization
TEXAS INDEPENDENCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARKETA JOHNSON (OWNER/ADMINISTRATOR)
(414) 625-0037
Entity
Organization
Contact information
Practice address
3653 TIMBERGLEN RD APT 735, DALLAS, TX 75287-3574
(414) 625-0037
Mailing address
18950 LINA ST APT 828, DALLAS, TX 75287-2449
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/21/2011
Last updated
09/21/2011
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