Provider Demographics
NPI:1811171663
Name:NICK KNOX JR.
Entity type:Organization
Organization Name:NICK KNOX JR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:JR
Authorized Official - Credentials:N/A
Authorized Official - Phone:832-272-4799
Mailing Address - Street 1:7034 BALLINGER RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4058
Mailing Address - Country:US
Mailing Address - Phone:832-272-4799
Mailing Address - Fax:
Practice Address - Street 1:7034 BALLINGER RIDGE LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-4058
Practice Address - Country:US
Practice Address - Phone:832-272-4799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities