Provider Demographics
NPI:1912175431
Name:EAST TEXAS CASE MANAGEMENT REFERRAL SERVICE
Entity Type:Organization
Organization Name:EAST TEXAS CASE MANAGEMENT REFERRAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CORDEL
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MED LBSW
Authorized Official - Phone:903-295-0098
Mailing Address - Street 1:2300 BILL OWENS PKWY APT 915
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-3060
Mailing Address - Country:US
Mailing Address - Phone:203-241-5208
Mailing Address - Fax:903-295-0098
Practice Address - Street 1:2300 BILL OWENS PKWY APT 915
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-3060
Practice Address - Country:US
Practice Address - Phone:203-241-5208
Practice Address - Fax:903-295-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26290171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty