Provider Demographics
NPI:1548586720
Name:MENTAL HEALTH FACILITY
Entity Type:Organization
Organization Name:MENTAL HEALTH FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOORAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGHSOUDLOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-562-9180
Mailing Address - Street 1:556 BUFFALO CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-5328
Mailing Address - Country:US
Mailing Address - Phone:214-562-9180
Mailing Address - Fax:
Practice Address - Street 1:556 BUFFALO CREEK DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-5328
Practice Address - Country:US
Practice Address - Phone:214-562-9180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness