Healthcare Provider Details

I. General information

NPI: 1043343049
Provider Name (Legal Business Name): DEPT OF ASSISTIVE & REHAB SERV - DALLAS FIELD HEADQUARTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 GREENVILLE AVE STE 250
DALLAS TX
75206-1010
US

IV. Provider business mailing address

PO BOX 12866
AUSTIN TX
78711-2866
US

V. Phone/Fax

Practice location:
  • Phone: 214-378-2600
  • Fax:
Mailing address:
  • Phone: 512-377-0584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateTX

VIII. Authorized Official

Name: JOSEPH PAYNE
Title or Position: PROGRAM MANAGER
Credential:
Phone: 512-424-4092