1497470090 NPI number — RESTORATION HOUSE ALCOHOL AND DRUG EDUCATION SERVICES

Table of content: (NPI 1497470090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497470090 NPI number — RESTORATION HOUSE ALCOHOL AND DRUG EDUCATION SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESTORATION HOUSE ALCOHOL AND DRUG EDUCATION SERVICES
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:
1497470090
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 E AVENUE G
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KILLEEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76541-6152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-832-2027
Provider Business Mailing Address Fax Number:
832-240-3396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 CONGRESS AVE STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78701-3575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-832-2027
Provider Business Practice Location Address Fax Number:
832-240-3396
Provider Enumeration Date:
10/05/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HENDERSON
Authorized Official First Name:
THADDEUS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-713-8485

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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