Provider Demographics
NPI:1083072862
Name:BASEPOINT ACADEMY LLC
Entity Type:Organization
Organization Name:BASEPOINT ACADEMY LLC
Other - Org Name:BASEPOINT ACADEMY
Other - Org Type:Other Name
Authorized Official - Title/Position:COO CPHM
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SERPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-325-2584
Mailing Address - Street 1:711 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-9130
Mailing Address - Country:US
Mailing Address - Phone:972-325-2584
Mailing Address - Fax:972-552-5499
Practice Address - Street 1:713 W BROAD ST
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-9147
Practice Address - Country:US
Practice Address - Phone:972-325-2633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder