Healthcare Provider Details

I. General information

NPI: 1184618985
Provider Name (Legal Business Name): SOUTHWEST CARE ASSOCIATES LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 SMITH ST
TEXARKANA TX
75501-4083
US

IV. Provider business mailing address

PO BOX 12322
KNOXVILLE TN
37912-0322
US

V. Phone/Fax

Practice location:
  • Phone: 903-832-8644
  • Fax: 903-838-5982
Mailing address:
  • Phone: 865-938-4101
  • Fax: 865-938-7230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number112042
License Number StateTX

VIII. Authorized Official

Name: DELORES SMITH
Title or Position: SEC'Y/TREAS UFM INC-GEN PTR
Credential:
Phone: 865-938-4101