Provider Demographics
NPI:1659448355
Name:SPECIAL ABILITIES OF NORTH TEXAS, INC.
Entity Type:Organization
Organization Name:SPECIAL ABILITIES OF NORTH TEXAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREISEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-317-1515
Mailing Address - Street 1:1960 ARCHER AVE.
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077
Mailing Address - Country:US
Mailing Address - Phone:972-317-1515
Mailing Address - Fax:972-692-8170
Practice Address - Street 1:1960 ARCHER AVE.
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077
Practice Address - Country:US
Practice Address - Phone:972-317-1515
Practice Address - Fax:972-692-8170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116170261QA0600X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001001697Medicaid