Christian Life Residential Services

Primary specialty

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

Legal business name

CHRISTIAN LIFE RESIDENTIAL SERVICES

Doing business as

Martha Gail Miller

Practice address

226 E Royall Blvd
Malakoff, TX 75148-9110

Phone

(903) 489-9977

Fax

(903) 698-2827

NPI assigned

Oct 25, 2012

Last updated

Oct 25, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Martha Gail Miller

Title

Program Director

Phone

(903) 489-9977

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Martha Gail Miller Doing business as

Tax ID family

Christian Life Residential Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Martha Gail Miller

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Malakoff, TX
  • NPI 1972702298
  NPD tax ID

Locations

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

{
    "created_epoch": "1351123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351123200000",
    "number": "1578816799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "226 E ROYALL BLVD",
            "city": "MALAKOFF",
            "state": "TX",
            "postal_code": "751489110",
            "telephone_number": "903-489-9977",
            "fax_number": "903-698-2827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "226 E ROYALL BLVD",
            "city": "MALAKOFF",
            "state": "TX",
            "postal_code": "751489110",
            "telephone_number": "903-489-9977",
            "fax_number": "903-698-2827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTIAN LIFE RESIDENTIAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-25",
        "last_updated": "2012-10-25",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "GAIL",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "903-489-9977",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1972702298",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Martha Gail Miller",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Malakoff, TX
• Providers in Malakoff, TX by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2012; 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.