Provider Demographics
NPI:1710429352
Name:ETHEL ROW YOUTH SERVICES LLC
Entity Type:Organization
Organization Name:ETHEL ROW YOUTH SERVICES LLC
Other - Org Name:ETHEL ROW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:OTIS
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:318-308-6172
Mailing Address - Street 1:1603 FIELD CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-2666
Mailing Address - Country:US
Mailing Address - Phone:318-308-6172
Mailing Address - Fax:
Practice Address - Street 1:1603 FIELD CT
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-2666
Practice Address - Country:US
Practice Address - Phone:318-308-6172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX377518817251S00000X
TX37751817343900000X, 344800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251S00000XAgenciesCommunity/Behavioral Health
No344800000XTransportation ServicesAir Carrier