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Jeffrey Chonaworah Adisam
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Giddings, Texas
NPI 1851831911

Jeffrey Chonaworah Adisam is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Giddings, TX. Jeffrey Chonaworah Adisam practices in Giddings, TX. The NPI Number for Jeffrey Chonaworah Adisam is 1851831911 and holds a License No. (Texas).

The current practice location address for Jeffrey Chonaworah Adisam is 1087 E Independence St, Giddings, TX and can be reached out via phone at 720-277-7404.

Location: 1087 E Independence St, Giddings, TX, 78942-1434
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1851831911
Provider Name
Jeffrey Chonaworah Adisam
Credential
Provider Entity Type
Individual
Gender
Male
Address
1087 E Independence St, Giddings, TX, 78942-1434
Phone Number
720-277-7404
Fax Number
Provider Enumeration Date
03/08/2017
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
1087 E Independence St
City
Giddings
State
Texas
Zip
78942-1434
Phone Number
720-277-7404
Fax Number
person
Provider Business Mailing Address Details
Address
1087 E Independence St
City
Giddings
State
Texas
Zip
78942-1434
Phone Number
720-277-7404
Fax Number
person
Provider's Taxonomy Details 1
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.
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