=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629883160
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVID CASE MANAGEMENT SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2025
-----------------------------------------------------
Last Update Date | 03/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5414 BRIANA DEE DR
-----------------------------------------------------
City | ROSHARON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77583-4655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-356-4635
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1221
-----------------------------------------------------
City | MISSOURI CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77459-1221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-356-4635
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM DIRECTOR
-----------------------------------------------------
Name | MELISSA R THOMPSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-356-4635
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------