1053439380 NPI number — GERIATRIC MENTAL HEALTH SPECIALISTS INC

Table of content: (NPI 1053439380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053439380 NPI number — GERIATRIC MENTAL HEALTH SPECIALISTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERIATRIC MENTAL HEALTH SPECIALISTS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053439380
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 CANDLE PINE PL # 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THE WOODLANDS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77381-6436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-746-7284
Provider Business Mailing Address Fax Number:
936-273-3786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8039 SCYENE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75227-5534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-388-0424
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ORTEGA
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
800-746-7284

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 125999602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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