Provider Demographics
NPI: | 1932573003 |
---|---|
Name: | ASPEN'S TREATMENT FACILITY |
Entity Type: | Organization |
Organization Name: | ASPEN'S TREATMENT FACILITY |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | NIKISHA |
Authorized Official - Middle Name: | NICOLE |
Authorized Official - Last Name: | ALLEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 409-351-3211 |
Mailing Address - Street 1: | PO BOX 3342 |
Mailing Address - Street 2: | |
Mailing Address - City: | SPRING |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77383-3342 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2305 NORTH ST |
Practice Address - Street 2: | |
Practice Address - City: | BEAUMONT |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77702-1728 |
Practice Address - Country: | US |
Practice Address - Phone: | 409-351-3211 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-11-30 |
Last Update Date: | 2015-11-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 251S00000X | Agencies | Community/Behavioral Health | ||
No | 252Y00000X | Agencies | Early Intervention Provider Agency | ||
No | 261QC1500X | Ambulatory Health Care Facilities | Clinic/Center | Community Health | |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
No | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | |
No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | |
No | 385H00000X | Respite Care Facility | Respite Care |