1407590631 NPI number — CORE TWENTY-FOUR SERVICES INC

Table of content: (NPI 1407590631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407590631 NPI number — CORE TWENTY-FOUR SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORE TWENTY-FOUR SERVICES 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:
1407590631
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 DALLAS ST STE 119
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARGYLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76226-2681
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-886-8827
Provider Business Mailing Address Fax Number:
817-886-8526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 DALLAS ST STE 119
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARGYLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76226-2681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-368-9875
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2022

Additional Information

Authorized Official

Authorized Official Last Name:
EMERSON
Authorized Official First Name:
DEANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/RN CARE COORDINATOR
Authorized Official Telephone Number:
940-368-9875

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 021706 . This is a "HOME AND COMMUNITY SUPPORT SERVICES AGENCY LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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