Provider Demographics
NPI:1720385404
Name:FAMILY NETWORK OF EAST TEXAS
Entity Type:Organization
Organization Name:FAMILY NETWORK OF EAST TEXAS
Other - Org Name:THRESA A. CALDWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THRESA
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW-IPR
Authorized Official - Phone:936-560-4365
Mailing Address - Street 1:2912 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-5468
Mailing Address - Country:US
Mailing Address - Phone:936-560-6397
Mailing Address - Fax:
Practice Address - Street 1:2912 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-5468
Practice Address - Country:US
Practice Address - Phone:936-560-6397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27886251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180671302Medicaid