1972796498 NPI number — NEW HORIZONS RED BIRD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972796498 NPI number — NEW HORIZONS RED BIRD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW HORIZONS RED BIRD
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:
6
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:
1972796498
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5713 NORTHBROOK DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-728-9909
Provider Business Mailing Address Fax Number:
972-608-8925

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 RED BIRD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANBURY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-249-0149
Provider Business Practice Location Address Fax Number:
972-608-8925
Provider Enumeration Date:
08/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ELLIS
Authorized Official First Name:
JOANNA
Authorized Official Middle Name:
JONES
Authorized Official Title or Position:
QMRP
Authorized Official Telephone Number:
214-728-9909

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , 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)