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Tanita Shanta Sullivan
Substance Abuse Rehabilitation Facility in Willis, Texas
NPI 1659671147

Tanita Shanta Sullivan is a Substance Abuse Rehabilitation Facility based in Willis, TX. Tanita Shanta Sullivan practices in Willis, TX. The NPI Number for Tanita Shanta Sullivan is 1659671147 and holds a License No. (Texas).

The current practice location address for Tanita Shanta Sullivan is 13985 Broken Arrow Dr, Willis, TX and can be reached out via phone at 936-856-6136 and via fax at 936-856-7549.

Location: 13985 Broken Arrow Dr, Willis, TX, 77378-4323
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1659671147
Provider Name
Tanita Shanta Sullivan
Credential
Provider Entity Type
Individual
Gender
Female
Address
13985 Broken Arrow Dr, Willis, TX, 77378-4323
Phone Number
936-856-6136
Fax Number
936-856-7549
Provider Enumeration Date
10/29/2010
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
13985 Broken Arrow Dr
City
Willis
State
Texas
Zip
77378-4323
Phone Number
936-856-6136
Fax Number
936-856-7549
person
Provider Business Mailing Address Details
Address
13985 Broken Arrow Dr
City
Willis
State
Texas
Zip
77378-4323
Phone Number
936-856-6136
Fax Number
936-856-7549
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320600000X
License No.
()
Definition
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.
person
Provider's Taxonomy Details 2
Type
Residential Treatment Facilities
Classification
Residential Treatment Facility, Physical Disabilities
Speciality
-
Taxonomy
320700000X
License No.
()
Definition
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with physical disabilities and are not able to live independently.
person
Provider's Taxonomy Details 3
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
()
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
person
Provider's Taxonomy Details 4
Type
Residential Treatment Facilities
Classification
Substance Abuse Rehabilitation Facility
Speciality
-
Taxonomy
324500000X
License No.
()
Definition
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.
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