Provider Demographics
NPI:1821597139
Name:EDDIE'S REACHING OUT RESIDENTIAL CORPORATION
Entity type:Organization
Organization Name:EDDIE'S REACHING OUT RESIDENTIAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-646-3171
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:LONE STAR
Mailing Address - State:TX
Mailing Address - Zip Code:75668-0124
Mailing Address - Country:US
Mailing Address - Phone:903-646-3171
Mailing Address - Fax:903-656-0512
Practice Address - Street 1:338 BOND ST
Practice Address - Street 2:
Practice Address - City:LONE STAR
Practice Address - State:TX
Practice Address - Zip Code:75668-0230
Practice Address - Country:US
Practice Address - Phone:903-646-3171
Practice Address - Fax:903-656-0512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities