Provider Demographics
NPI:1396702122
Name:EASTER SEALS NORTH TEXAS, INC.
Entity type:Organization
Organization Name:EASTER SEALS NORTH TEXAS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-394-8900
Mailing Address - Street 1:633 3RD AVE FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6733
Mailing Address - Country:US
Mailing Address - Phone:817-542-1988
Mailing Address - Fax:866-834-4570
Practice Address - Street 1:4201 BROOK SPRING DR
Practice Address - Street 2:BLDG. II
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4968
Practice Address - Country:US
Practice Address - Phone:972-394-8900
Practice Address - Fax:214-372-3304
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTER SEALS CENTRAL TEXAS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-26
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1991986-01Medicaid
TX1528119-01Medicaid
TX1528119-02OtherCHSCN
TX1528119-01Medicaid