Tanita Shanta Sullivan

Individual provider Intellectual and/or Developmental Disabilities Residential Treatment Facility · NPI 1659671147

Tanita Shanta Sullivan is an Intellectual and/or Developmental Disabilities Residential Treatment Facility in Willis, Texas. Practices as a sole proprietor. Registered with an NPI since 2010.

In the registry since: 2010
Specialties on file: 4

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Practice location Address checks out

13985 Broken Arrow Dr
Willis, TX 77378-4323
Phone: (936) 856-6136
Fax: (936) 856-7549

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Specialties & licences

Intellectual and/or Developmental Disabilities Residential Treatment Facility (primary)	Taxonomy 320600000X
Physical Disabilities Residential Treatment Facility	Taxonomy 320700000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	Taxonomy 320900000X
Substance Abuse Rehabilitation Facility	Taxonomy 324500000X

Record details

NPI number	1659671147
Entity type	Individual (Type 1)
Gender	Female
Sole proprietor	Yes
NPI enumerated	October 29, 2010
Last updated in NPPES	October 29, 2010