Provider Demographics
NPI:1932138773
Name:INNOVATIVE HOMES OF DEEP EAST TEXAS, INC.
Entity Type:Organization
Organization Name:INNOVATIVE HOMES OF DEEP EAST TEXAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRO
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW, CART
Authorized Official - Phone:936-639-5273
Mailing Address - Street 1:PO BOX 150925
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75915-0925
Mailing Address - Country:US
Mailing Address - Phone:936-639-5273
Mailing Address - Fax:936-639-5286
Practice Address - Street 1:513 S 1ST ST
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-3867
Practice Address - Country:US
Practice Address - Phone:936-639-5273
Practice Address - Fax:936-639-5286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities