Provider Demographics
NPI:1033727060
Name:FRIENDS PLACE SOUTHWEST LLC
Entity Type:Organization
Organization Name:FRIENDS PLACE SOUTHWEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYLYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-274-2484
Mailing Address - Street 1:1232 W BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3738
Mailing Address - Country:US
Mailing Address - Phone:972-274-2484
Mailing Address - Fax:972-274-0002
Practice Address - Street 1:1232 W BELT LINE RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-3738
Practice Address - Country:US
Practice Address - Phone:972-274-2484
Practice Address - Fax:972-274-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care