1689915795 NPI number — TOTAL CHILD THERAPY HOME HEALTH PLLC

Table of content: DR. DE'ARCO RASHAUN MCCREARY M.D. (NPI 1750624508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689915795 NPI number — TOTAL CHILD THERAPY HOME HEALTH PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL CHILD THERAPY HOME HEALTH PLLC
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:
1689915795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
407 S OLD HIGHWAY 81
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KYLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78640-5310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-504-3035
Provider Business Mailing Address Fax Number:
521-504-9287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 S OLD HIGHWAY 81
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KYLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78640-5310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-504-3035
Provider Business Practice Location Address Fax Number:
521-504-9287
Provider Enumeration Date:
03/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SHINTO
Authorized Official First Name:
EMYLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
512-504-3035

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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