Provider Demographics
NPI:1558563197
Name:ANDERSON CHEROKEE COMMUNITY ENRICHMENT SERVICES
Entity Type:Organization
Organization Name:ANDERSON CHEROKEE COMMUNITY ENRICHMENT SERVICES
Other - Org Name:ACCESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REIMBURSEMENT COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-589-9000
Mailing Address - Street 1:5656 NORTH JACKSON
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-9641
Mailing Address - Country:US
Mailing Address - Phone:903-589-9000
Mailing Address - Fax:903-589-3443
Practice Address - Street 1:5656 NORTH JACKSON
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-9641
Practice Address - Country:US
Practice Address - Phone:903-589-9000
Practice Address - Fax:903-589-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1007139OtherCONTRACT NUMBER
TX1007139OtherCONTRACT NUMBER