Provider Demographics
NPI:1275592370
Name:ANDREWS CENTER
Entity Type:Organization
Organization Name:ANDREWS CENTER
Other - Org Name:ECI SERVICE COORDINATION
Other - Org Type:Former Legal Business Name
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 1:1722 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-6823
Mailing Address - Country:US
Mailing Address - Phone:903-597-5067
Mailing Address - Fax:903-597-6223
Practice Address - Street 1:1722 W FRONT ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-6823
Practice Address - Country:US
Practice Address - Phone:903-597-5067
Practice Address - Fax:903-597-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138365506Medicaid
TX138365506Medicaid