Provider Demographics
NPI:1801115670
Name:SET APART AIMING VICTORIOUSLY TO ELIMINATE DISEASES
Entity type:Organization
Organization Name:SET APART AIMING VICTORIOUSLY TO ELIMINATE DISEASES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TYESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-815-9035
Mailing Address - Street 1:5001 BRENTWOOD STAIR RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-2801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5001 BRENTWOOD STAIR RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-2801
Practice Address - Country:US
Practice Address - Phone:972-815-9035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251300000X, 251B00000X, 251V00000X, 252Y00000X, 347B00000X, 347C00000X
TX45D2003213291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
No252Y00000XAgenciesEarly Intervention Provider Agency
No347B00000XTransportation ServicesBus
No347C00000XTransportation ServicesPrivate Vehicle