Provider Demographics
NPI:1790948842
Name:NORTHVIEW DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:NORTHVIEW DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-629-2624
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:EASTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76448-0148
Mailing Address - Country:US
Mailing Address - Phone:254-629-2624
Mailing Address - Fax:254-629-3950
Practice Address - Street 1:401 W MOSS ST
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448-1754
Practice Address - Country:US
Practice Address - Phone:254-629-2624
Practice Address - Fax:254-629-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123425315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities