Provider Demographics
NPI:1679531503
Name:MAINSTREAM HABILITATION SERVICES OF TEXAS, INC.
Entity type:Organization
Organization Name:MAINSTREAM HABILITATION SERVICES OF TEXAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:940-552-2979
Mailing Address - Street 1:PO BOX 1677
Mailing Address - Street 2:1728 PEASE STREET
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76385-1677
Mailing Address - Country:US
Mailing Address - Phone:940-552-2979
Mailing Address - Fax:940-552-2987
Practice Address - Street 1:717 MOUNTAIN RIDGE CT W
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:TX
Practice Address - Zip Code:76135-4925
Practice Address - Country:US
Practice Address - Phone:817-237-8329
Practice Address - Fax:817-238-9606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116454315P00000X
TX116728315P00000X
TX116726315P00000X
TX112011315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities