1366758062 NPI number — SULLIVAN HELP CENTER CORPORATION

Table of content: DWAYNE HUSKEY OTR (NPI 1073992855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366758062 NPI number — SULLIVAN HELP CENTER CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SULLIVAN HELP CENTER CORPORATION
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:
1366758062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13985 BROKEN ARROW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77378-4323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-856-6136
Provider Business Mailing Address Fax Number:
936-856-7549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15710 BOND LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONROE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77303-4183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-549-1364
Provider Business Practice Location Address Fax Number:
855-693-4662
Provider Enumeration Date:
08/19/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SULLIVAN
Authorized Official First Name:
TANITA
Authorized Official Middle Name:
SHANTA
Authorized Official Title or Position:
PROGRAM MANAGER
Authorized Official Telephone Number:
936-856-6136

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 372600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2050X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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