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General NPI Number Information
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NPI Number | 1083181846
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Entity Type | Organization
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Legal Business Name | MANAGED SERVICE GROUP
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Dates
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Enumeration Date | 10/30/2018
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Last Update Date | 12/10/2019
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Provider Practice Location Address
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Address Line | 22 BRIERCROFT OFFICE PARK STE 3
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City | LUBBOCK
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State | TX
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Zip | 79412-3089
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Country | US
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Telephone | 800-516-7760
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3554
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City | MCKINNEY
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State | TX
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Zip | 75070-8194
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Country | US
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Telephone | 214-536-4818
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | NICOLE CLARKE-SMITH
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Credential |
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Telephone | 800-516-7760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM3000X
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Taxonomy Name | Medically Fragile Infants and Children Day Care
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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