Provider Demographics
NPI:1083638688
Name:ANDREWS CENTER/ ANN RD
Entity Type:Organization
Organization Name:ANDREWS CENTER/ ANN RD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-597-1351
Mailing Address - Street 1:3109 COUNTY ROAD 4167
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75704-6101
Mailing Address - Country:US
Mailing Address - Phone:903-597-8823
Mailing Address - Fax:
Practice Address - Street 1:3109 COUNTY ROAD 4167
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75704-6101
Practice Address - Country:US
Practice Address - Phone:903-597-8823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities