1174676415 NPI number — TEXARKANA SPECIAL EDUCATION CENTER, INC.

Table of content: (NPI 1174676415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174676415 NPI number — TEXARKANA SPECIAL EDUCATION CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXARKANA SPECIAL EDUCATION CENTER, 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:
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:
1174676415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6101 N STATE LINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75503-5309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-791-2270
Provider Business Mailing Address Fax Number:
903-792-0816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6101 N STATE LINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75503-5309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-791-2270
Provider Business Practice Location Address Fax Number:
903-792-0816
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
SHERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
903-791-2270

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  DDS COMMUNITY PROGRA , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251C00000X , with the licence number: 116956 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , with the licence number: PT1532 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , with the licence number: SP#477 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , with the licence number: 1158790 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , with the licence number: 100348 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , with the licence number: 109611 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , with the licence number: 152450 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA0600X , with the licence number: 116469 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: DDS COMMUNITY PROGRA , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 103422724 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121414732 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132790767 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1575342-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1760274-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001000533 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0023GT . This is a "PRIVATE INSURANCE BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0174476-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116391742 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135693721 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146240778 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 149109755 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0056749-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116527721 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 130429774 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001004554 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 119195715 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132655786 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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