Provider Demographics
NPI:1235278144
Name:RONALD MCDONALD HOUSE CHARITIES OF THE SOUTHWEST INC
Entity Type:Organization
Organization Name:RONALD MCDONALD HOUSE CHARITIES OF THE SOUTHWEST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:CFRE
Authorized Official - Phone:806-744-8877
Mailing Address - Street 1:1212 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79415-3366
Mailing Address - Country:US
Mailing Address - Phone:806-744-8877
Mailing Address - Fax:806-744-3652
Practice Address - Street 1:1212 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3366
Practice Address - Country:US
Practice Address - Phone:806-744-8877
Practice Address - Fax:806-744-3652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodgingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0000K1055Medicaid
TX0065931401OtherCHARTER ID STATE OF TEXAS
NM0000K1055Medicaid