1487678025 NPI number — PLANNED LIVING ASSISTANCE NETWORK OF NORTH TEXAS INC

Table of content: (NPI 1487678025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487678025 NPI number — PLANNED LIVING ASSISTANCE NETWORK OF NORTH TEXAS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLANNED LIVING ASSISTANCE NETWORK OF NORTH TEXAS INC
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:
PLAN OF NORTH TEXAS
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:
1487678025
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13151 EMILY RD
Provider Second Line Business Mailing Address:
SUITE 240
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75240-8989
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-690-7526
Provider Business Mailing Address Fax Number:
972-690-3009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13151 EMILY RD
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75240-8989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-690-7526
Provider Business Practice Location Address Fax Number:
972-690-3009
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GREGORY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
J
Authorized Official Title or Position:
BOARD CHAIR
Authorized Official Telephone Number:
972-690-7526

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 080794302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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