Provider Demographics
NPI:1700805959
Name:HAYWOOD SERVICES L.L.C.
Entity Type:Organization
Organization Name:HAYWOOD SERVICES L.L.C.
Other - Org Name:KIDZ FIRST THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:903-295-0099
Mailing Address - Street 1:PO BOX 9625
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608-9625
Mailing Address - Country:US
Mailing Address - Phone:903-295-0099
Mailing Address - Fax:903-295-0099
Practice Address - Street 1:593 WINDRIDGE RD
Practice Address - Street 2:
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75645-6949
Practice Address - Country:US
Practice Address - Phone:903-295-0099
Practice Address - Fax:903-295-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208665224Z00000X
TX10182992251P0200X
TX1132302251P0200X
TX2009718225200000X
TX103105225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty