Provider Demographics
NPI:1710179171
Name:NORTH NINTH HOUSE
Entity Type:Organization
Organization Name:NORTH NINTH HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-677-6815
Mailing Address - Street 1:PO BOX 1880
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-1880
Mailing Address - Country:US
Mailing Address - Phone:325-677-6815
Mailing Address - Fax:325-673-7829
Practice Address - Street 1:4210 N 9TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-5464
Practice Address - Country:US
Practice Address - Phone:325-677-6815
Practice Address - Fax:325-673-7829
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DISABILITY RESOURCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-09
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000781401320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000781401OtherTEXAS DEPARTMENT OF AGING AND DISABILITIES