Provider Demographics
NPI:1760089767
Name:FIFTH DIRECTION
Entity Type:Organization
Organization Name:FIFTH DIRECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:281-780-9014
Mailing Address - Street 1:4320 AVENUE R 1/2 REAR
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-7346
Mailing Address - Country:US
Mailing Address - Phone:281-780-9014
Mailing Address - Fax:
Practice Address - Street 1:4320 AVENUE R 1/2 REAR
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-7346
Practice Address - Country:US
Practice Address - Phone:281-619-8550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility