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General NPI Number Information
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NPI Number | 1235153842
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Entity Type | Organization
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Legal Business Name | ANDREWS CENTER/CHOCTAW
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13470 CHOCTAW DR
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City | TYLER
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State | TX
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Zip | 75709-5000
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Country | US
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Telephone | 903-595-1443
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Fax |
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Provider Business Mailing Address
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Address Line | 13470 CHOCTAW DR
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City | TYLER
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State | TX
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Zip | 75709-5000
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | CAROL FONTENOT
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Credential |
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Telephone | 903-597-1351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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