1467595827 NPI number — TURTLE CREEK MANOR, INC.

Table of content: (NPI 1467595827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467595827 NPI number — TURTLE CREEK MANOR, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TURTLE CREEK MANOR, 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:
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:
1467595827
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2820 SWISS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75204-5958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-522-7930
Provider Business Mailing Address Fax Number:
214-522-7952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2707 ROUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75201-1927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-871-2483
Provider Business Practice Location Address Fax Number:
214-871-3042
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CASTANEDA
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
214-522-7930

Provider Taxonomy Codes

  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 324500000X , with the licence number: 264-A , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





Copyright © 2007-2025 www.npivalidator.com