Healthcare Provider Details

I. General information

NPI: 1205999232
Provider Name (Legal Business Name): HICKORY TRAIL HOSPITAL, L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OLD HICKORY TRL
DESOTO TX
75115-2242
US

IV. Provider business mailing address

2000 OLD HICKORY TRL
DESOTO TX
75115-2242
US

V. Phone/Fax

Practice location:
  • Phone: 972-298-7323
  • Fax: 972-709-0581
Mailing address:
  • Phone: 972-298-7323
  • Fax: 972-709-0581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number008378
License Number StateTX

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: SRVP CFO
Credential:
Phone: 610-678-3300