1518469527 NPI number — SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED

Table of content: (NPI 1518469527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518469527 NPI number — SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED
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:
TRUE NORTH HEALTH CENTER
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:
1518469527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2709
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGVIEW
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75606-2709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-234-0776
Provider Business Mailing Address Fax Number:
904-234-9769

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1011 COLLEGE STREET
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:
75766-3307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-541-2571
Provider Business Practice Location Address Fax Number:
903-284-6830
Provider Enumeration Date:
03/06/2018

Additional Information

Authorized Official

Authorized Official Last Name:
NESVIG
Authorized Official First Name:
KIM
Authorized Official Middle Name:
DALE
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER (CEO)
Authorized Official Telephone Number:
903-234-0776

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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