1083957815 NPI number — SOUTHERN COMFORT BEHAVIORAL HEALTH CENTER, LLC.

Table of content: (NPI 1083957815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083957815 NPI number — SOUTHERN COMFORT BEHAVIORAL HEALTH CENTER, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN COMFORT BEHAVIORAL HEALTH CENTER, LLC.
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:
SOUTHERN COMFORT BHC
Provider Other Organization Name Type Code:
3
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:
1083957815
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9146 EASTEX FWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77093-7020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-426-4697
Provider Business Mailing Address Fax Number:
832-426-4996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9146 EASTEX FWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77093-7020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-426-4697
Provider Business Practice Location Address Fax Number:
832-426-4996
Provider Enumeration Date:
03/29/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
CHERRELLE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
832-969-7464

Provider Taxonomy Codes

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

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

  • Identifier: 193116404 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1932453008 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1528341492 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".