Provider Demographics
NPI:1508092917
Name:ENTERPRISE PEDIATRIC CENTER OF DENISON LLC
Entity Type:Organization
Organization Name:ENTERPRISE PEDIATRIC CENTER OF DENISON LLC
Other - Org Name:LIFESTEPS OF DENISON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:903-462-4085
Mailing Address - Street 1:2300 W MORTON ST
Mailing Address - Street 2:STE 114
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-1671
Mailing Address - Country:US
Mailing Address - Phone:903-462-4085
Mailing Address - Fax:
Practice Address - Street 1:2300 W MORTON ST
Practice Address - Street 2:STE 114
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-1671
Practice Address - Country:US
Practice Address - Phone:903-462-4085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)