Provider Demographics
NPI:1730303561
Name:AUSTIN CHILDREN'S SHELTER
Entity Type:Organization
Organization Name:AUSTIN CHILDREN'S SHELTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-499-0090
Mailing Address - Street 1:804 RIO GRANDE ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2201
Mailing Address - Country:US
Mailing Address - Phone:512-499-0090
Mailing Address - Fax:512-499-0438
Practice Address - Street 1:1501 ENFIELD RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-3404
Practice Address - Country:US
Practice Address - Phone:512-499-0090
Practice Address - Fax:512-499-0438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty