Provider Demographics
NPI:1942966502
Name:EATING DISORDER SOLUTIONS OF TEXAS LLC
Entity Type:Organization
Organization Name:EATING DISORDER SOLUTIONS OF TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NIZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-478-7488
Mailing Address - Street 1:PO BOX 734612
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-4612
Mailing Address - Country:US
Mailing Address - Phone:877-478-7488
Mailing Address - Fax:972-692-8034
Practice Address - Street 1:1664 WHIPPOORWILL TRL
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76085-6740
Practice Address - Country:US
Practice Address - Phone:877-478-7488
Practice Address - Fax:305-930-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility