OrganizationActive
A Way of Life Services
NPI 1306436647 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Dallas, TX
Provider details
- NPI number
- 1306436647
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Larrymi Mathis, Ceo(469) 735-3395
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000X
Residential Treatment Facilities
Agencies
- In Home Supportive Care Agency253Z00000X
Agencies
Practice location
3455 Highland Rd # 101
Dallas, TX 75228-7193
Phone: (469) 735-5852
Fax: (469) 941-4158
Approximate (ZIP-level) locationGet directions
Mailing address
8501 Baumgarten Dr
Dallas, TX 75228-5416
Registry dates
- Enumerated
- 2021-01-20
- Last updated
- 2023-08-08
- Certified
- 2021-01-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.