Tracie Ellen Angelly

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

TRACIE ELLEN ANGELLY

Practice address

411 Brumbelow Rd
Whitt, TX 76490-2306

Phone

(940) 859-1955

Fax

(940) 798-4412

NPI assigned

Dec 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tracie Ellen Angelly

Title

Administrator

Phone

(940) 859-1955

Specialties & licenses 2

Addresses

Other names 1

• Texas Freedom Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194881276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 BRUMBELOW RD",
            "city": "WHITT",
            "state": "TX",
            "postal_code": "764902306",
            "telephone_number": "940-859-1955",
            "fax_number": "940-798-4412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 BRUMBELOW RD",
            "city": "WHITT",
            "state": "TX",
            "postal_code": "764902306",
            "telephone_number": "940-859-1955",
            "fax_number": "940-798-4412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACIE ELLEN ANGELLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ANGELLY",
        "authorized_official_first_name": "TRACIE",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "940-859-1955"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "TX",
            "license": null,
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "TX",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Texas Freedom",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.