Provider Demographics
NPI:1194854216
Name:HIGHER DIMENSIONAL FELLOWSHIP
Entity Type:Organization
Organization Name:HIGHER DIMENSIONAL FELLOWSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-205-9810
Mailing Address - Street 1:PO BOX 461322
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75046-1322
Mailing Address - Country:US
Mailing Address - Phone:972-205-9810
Mailing Address - Fax:972-205-9221
Practice Address - Street 1:916 NORTH JUPITER RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5441
Practice Address - Country:US
Practice Address - Phone:972-205-9810
Practice Address - Fax:972-205-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities