1154522498 NPI number — CENTRAL PLAINS CENTER ICF

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154522498 NPI number — CENTRAL PLAINS CENTER ICF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL PLAINS CENTER ICF
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:
ICF
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:
1154522498
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/03/2008
NPI Reactivation Date:
07/25/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 YONKERS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINVIEW
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79072-1826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-293-2636
Provider Business Mailing Address Fax Number:
806-296-5804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 ENNIS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79072-1826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-291-4450
Provider Business Practice Location Address Fax Number:
806-291-4480
Provider Enumeration Date:
05/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TRUSLER
Authorized Official First Name:
RON
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
806-293-2636

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000393901 . This is a "ICF" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 000393901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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