Provider Demographics
NPI:1508101254
Name:BEST FRIENDS ADULT ACTIVITY CTR, INC.
Entity Type:Organization
Organization Name:BEST FRIENDS ADULT ACTIVITY CTR, INC.
Other - Org Name:THE SPRING HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROYAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-753-1795
Mailing Address - Street 1:3839 GILMER RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-1132
Mailing Address - Country:US
Mailing Address - Phone:903-295-1237
Mailing Address - Fax:
Practice Address - Street 1:503 S GREEN ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-7536
Practice Address - Country:US
Practice Address - Phone:903-753-1795
Practice Address - Fax:903-753-1795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid