Provider Demographics
NPI:1467595827
Name:TURTLE CREEK MANOR, INC.
Entity Type:Organization
Organization Name:TURTLE CREEK MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CASTANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-522-7930
Mailing Address - Street 1:2820 SWISS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-5958
Mailing Address - Country:US
Mailing Address - Phone:214-522-7930
Mailing Address - Fax:214-522-7952
Practice Address - Street 1:2707 ROUTH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-1927
Practice Address - Country:US
Practice Address - Phone:214-871-2483
Practice Address - Fax:214-871-3042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320800000X
TX264-A324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Not Answered324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility