1114761996 NPI number — ANDERSON CHEROKEE COMMUNITY ENRICHMENT SERVICES

Table of content: (NPI 1114761996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114761996 NPI number — ANDERSON CHEROKEE COMMUNITY ENRICHMENT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDERSON CHEROKEE COMMUNITY ENRICHMENT SERVICES
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:
6
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:
1114761996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1011 COLLEGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75766-3307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-541-2577
Provider Business Mailing Address Fax Number:
903-586-9200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
597 S RAGSDALE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75766-2434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-589-0990
Provider Business Practice Location Address Fax Number:
903-586-9200
Provider Enumeration Date:
06/25/2024

Additional Information

Authorized Official

Authorized Official Last Name:
STROM
Authorized Official First Name:
DIANNA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
REIMBURSEMENT COORDINATOR
Authorized Official Telephone Number:
903-541-2577

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com