Provider Demographics
NPI: | 1164597142 |
---|---|
Name: | ANDREWS CENTER-PARTIAL HOSPITALIZATOIN |
Entity Type: | Organization |
Organization Name: | ANDREWS CENTER-PARTIAL HOSPITALIZATOIN |
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: | 2323 W FRONT ST |
Mailing Address - Street 2: | |
Mailing Address - City: | TYLER |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75702-7704 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 903-597-1351 |
Mailing Address - Fax: | 903-535-7386 |
Practice Address - Street 1: | 2323 W FRONT ST |
Practice Address - Street 2: | |
Practice Address - City: | TYLER |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75702-7704 |
Practice Address - Country: | US |
Practice Address - Phone: | 903-597-1351 |
Practice Address - Fax: | 903-535-7386 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-11-22 |
Last Update Date: | 2007-09-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 45-4911 | Medicare ID - Type Unspecified |