1730525759 NPI number — VCPHCS XVIII,LLC

Table of content: (NPI 1730525759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730525759 NPI number — VCPHCS XVIII,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VCPHCS XVIII,LLC
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:
TEXAS TREATMENT CENTER-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:
1730525759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8300 DOUGLAS AVE
Provider Second Line Business Mailing Address:
SUITE 750
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75225-5603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-365-6100
Provider Business Mailing Address Fax Number:
214-365-6150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 TENAHA ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
CENTER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75935-3036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-598-6608
Provider Business Practice Location Address Fax Number:
936-598-6618
Provider Enumeration Date:
05/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DRAUDT
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
FREDERICK
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
214-365-6111

Provider Taxonomy Codes

  • Taxonomy code: 261QM2800X , with the licence number:  1000039 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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