Provider Demographics
NPI:1710279377
Name:CHURCHILL EVALUATION CENTERS
Entity Type:Organization
Organization Name:CHURCHILL EVALUATION CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-861-4600
Mailing Address - Street 1:PO BOX 120965
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-0965
Mailing Address - Country:US
Mailing Address - Phone:817-861-4600
Mailing Address - Fax:
Practice Address - Street 1:2225 E RANDOL MILL RD STE 101
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-6354
Practice Address - Country:US
Practice Address - Phone:817-861-4600
Practice Address - Fax:817-377-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty