Healthcare Provider Details

I. General information

NPI: 1255497848
Provider Name (Legal Business Name): DEPARTMENT OF THE ARMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36000 DARNALL LOOP DEPARTMENT OF SUBSTANCE ABUSE SERVICES
FORT HOOD TX
76544-5095
US

IV. Provider business mailing address

3262 COLORADO DR
COPPERAS COVE TX
76522-3310
US

V. Phone/Fax

Practice location:
  • Phone: 254-287-2892
  • Fax:
Mailing address:
  • Phone: 254-833-1465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number34229
License Number StateTX

VIII. Authorized Official

Name: DONALD L SCHUMAN
Title or Position: SUPERVISORY SOCIAL WORKER
Credential: LCSW, LCDC
Phone: 254-287-2892