Provider Demographics
NPI:1336406065
Name:TEXAS TECH EARLY HEAD START
Entity Type:Organization
Organization Name:TEXAS TECH EARLY HEAD START
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-742-3200
Mailing Address - Street 1:515 N ZENITH AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79403-3610
Mailing Address - Country:US
Mailing Address - Phone:806-765-2737
Mailing Address - Fax:806-765-2735
Practice Address - Street 1:515 N ZENITH AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79403-3610
Practice Address - Country:US
Practice Address - Phone:806-765-2737
Practice Address - Fax:806-765-2735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable