1205310877 NPI number — ANGELS DAY REHABILITATION CENTER

Table of content: (NPI 1205310877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205310877 NPI number — ANGELS DAY REHABILITATION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGELS DAY REHABILITATION CENTER
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:
1205310877
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4017 SMARTT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROWLETT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75088-4953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-429-1691
Provider Business Mailing Address Fax Number:
469-573-6239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 PIONEER RD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESQUITE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75149-5286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-429-1691
Provider Business Practice Location Address Fax Number:
469-573-6239
Provider Enumeration Date:
09/19/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BROOKS
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRETOR
Authorized Official Telephone Number:
214-429-1691

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com