1922286178 NPI number — AUTISTIC TREATMENT CENTER, INC.

Table of content: (NPI 1922286178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922286178 NPI number — AUTISTIC TREATMENT CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUTISTIC TREATMENT 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:
1922286178
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10503 METRIC DR
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:
75243-5514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-644-2076
Provider Business Mailing Address Fax Number:
972-644-5650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10610 METRIC DR
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75243-5541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-221-4405
Provider Business Practice Location Address Fax Number:
214-221-4463
Provider Enumeration Date:
02/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HUNDLEY
Authorized Official First Name:
ANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
972-644-2076

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 556500000 . This is a "EPOTC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 204108901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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